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1. How satisfied are you with  the following aspects of our services?

1. Knowledge demonstrated by staff

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2. Responsiveness of staff to your needs

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3. Usefulness of Information/assistance provided

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4. Overall quality of the services provided

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5. How can we improve our service delivery to you?.

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6. What topic or skill area was addressed by the training and/or technical assistance we provided? (i.e. diabete management, quality improvement, EMR, OSZV, PCMH)

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7. To what degree to you feel you have improved your knowledge or skills as a result of your work with us? Complete one line for each topic or skill area addressed by the training and/or technical assistance provided. (i.e. diabetes
management, quality improvement, EMR, OSV, PCMH)

  No Improvement Minimal Improvement Moderate Improvement Large Improvement Not Sure
Diabetes Management
Quality Improvement
EMR
OSV
PCMH

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8. To what degree do you feel your organization has improved your knowledge or skills as a result of your work with us? Complete one line for each topic or skill area addressed by the training and/or technical assistance provided. (i.e. diabetes management, quality improvement, EMR, OSV, PCMH)

  No Improvement Minimal Improvement Moderate Improvement Large Improvement Not Sure
Diabetes Management
Quality Improvement
EMR
OSV
PCMH

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9. To what degree do you feel your organization has improved its capacity in the following areas as a result of your work with us? Complete one line for each topic or skill area addressed by the training and/or technical assistance provided. (i.e. diabetes management, quality improvement, EMR, OSV, PCMH)

  No Improvement Minimal Improvement Moderate Improvement Large Improvement Not Sure
Diabetes Management
Quality Improvement
EMR
OSV
PCMH

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10. What do you feel is the most valuable result of your work with us?

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11. What additional technical assistance or trainings do you think would help or enhance your organization right now?

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12. Please provide any other comments, questions or concerns.

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