INSTRUCTIONS

The Montgomery County Board of Developmental Disabilities Services (MCBDDS) would like your opinion regarding the quality and type of services it has provided during the past 12 months to you or your family member/ward.  We would like individuals to complete this survey as independently as possible, and have family members/guardians/providers complete a separate survey.  Additional copies of the survey can be downloaded at http://www.mcbdds.org/survey

The following survey asks general questions AND questions specific to departments and functions.  If you or your loved one do not receive services from a particular department, please skip that section of the survey and move to the next.

You may receive this survey in paper and electronic form. We ask that you complete one or the other, but not both, by July 15, 2018 at 11:59 p.m.  If you return a completed survey and provide your name and address, you will be entered into a drawing to win a $100 Visa gift card.  To return the survey via U.S. Mail, please send it to: MCBDDS Communications Dept., 5450 Salem Avenue, Dayton, OH 45426.

If you would like someone from the Board's administrative team to follow up with you regarding any concerns, please include your name and phone number in the comments section at the end of this survey.  Thank you for your time. 

I am:

Question Title

* 1. I am:

My age group (check one):

Question Title

* 2. My age group (check one):

What is your gender?

Question Title

* 3. What is your gender?

What race/ethnicity best describes you?

Question Title

* 4. What race/ethnicity best describes you?

I wish to be entered into the drawing for the $100 Visa Gift Card.  My name and address are:

Question Title

* 5. I wish to be entered into the drawing for the $100 Visa Gift Card.  My name and address are:

T