1. Client Satisfaction Survey

Thank you for contacting us!
Please take a moment to complete this survey about your most recent experience with the Chapter. Please rate each question on a scale of 1-5 with 1= very poor and 5= very good. Your comments help us provide the highest level of service to our callers.

* 1. Communication

  Very Poor Poor Fair Good Very Good
Promptness of response to your phone call or email

* 2. Communication

  Very Poor Poor Fair Good Very Good
How well staff member listened to your requests

* 3. Communication

  Very Poor Poor Fair Good Very Good
Courtesy of the person who answered your call

* 4. Communication

  Very Poor Poor Fair Good Very Good
Staff member's sensitivity to your needs

* 5. Communication

  Very Poor Poor Fair Good Very Good
Degree to which staff member communicated the information clearly

* 6. Communication

  Very Poor Poor Fair Good Very Good
How well your questions were answered

* 7. Communication

  Very Poor Poor Fair Good Very Good
Degree to which you were encouraged to call back for additional information and/ or service

* 8. Service

  Very Poor Poor Fair Good Very Good
Likelihood of using this Information and Refferal Service again

* 9. Service

  Very Poor Poor Fair Good Very Good
Likelihood of recommending this service to someone else coping with MS

* 10. Additional Comments or Requests

* 11. If you would like to be on our mailing list, please complete the information below.

* 12. Please tell us, are you:

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