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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.)

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2. LIFE Staff treated you in a friendly, caring and respectful manner. (Required.)

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3. LIFE services were provided in a timely manner. (Required.)

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4. LIFE Staff encouraged you to make decisions so you can live more independently. (Required.)

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5. LIFE services met your needs. (Required.)

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6. LIFE services gave you enough information to make informed decisions. (Required.)

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7. I am satisfied with services provided by LIFE Inc.

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8. Optional - Based on your experience, what could the Center do to improve services?

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9. Optional - Please provide the name(s) of the LIFE staff who assisted you with services.

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10. Optional - Please enter your contact information.

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