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Consumer Satisfaction Survey - LIFE26
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1.
Please indicate the services you now receive or have received in the past from LIFE Inc. Check all that apply.
(Required.)
Advocacy
Independent Living Skills Training
Information & Referral
Health & Fitness/Social & Recreational
Housing (help finding or retaining accessible/affordable housing)
Peer Support
Purchased Services (e.g., hearing aids, prosthesis, vehicle modification, wheelchair, ramp, lift chair, etc.)
Social Security Representative Payee Services
Youth Transition
Transition from Nursing Facility to Community
Other (please specify)
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2.
LIFE Staff treated you in a friendly, caring and respectful manner.
(Required.)
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comment (optional)
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3.
LIFE services were provided in a timely manner.
(Required.)
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comment (optional)
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4.
LIFE Staff encouraged you to make decisions so you can live more independently.
(Required.)
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comment (optional)
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5.
LIFE services met your needs.
(Required.)
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comment (optional)
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6.
LIFE services gave you enough information to make informed decisions.
(Required.)
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comments (optional)
7.
I am satisfied with services provided by LIFE Inc.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Comment (optional)
8.
Optional - Based on your experience, what could the Center do to improve services?
9.
Optional - Please provide the name(s) of the LIFE staff who assisted you with services.
10.
Optional - Please enter your contact information.
Name
Email Address
Cell Phone Number
