* 1. Overall, how would you rate the program or services you received?

* 2. How would you rate the way the staff treated you?

* 3. How would you rate the reliability of the program staff in doing what they said they would do?

* 4. How would you rate the timeliness of the program staff in responding to your questions or problems?

* 5. If you had a friend who was in need of the same or similar services you received, how likely is it that you would recommend the program or service to him or her?

* 6. How likely are you to seek services from this agency again?

* 7. Please provide any other comments about your experience that you would like to share.

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