Client Survey to Evaluate Services

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* 1. What is your zip code

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* 2. What city do you live in?

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* 3. Please check service(s) received from agency:

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* 4. Describe how satisfied you are with the services you received from the agency by check the rating with best describes your experience.

  No opinion Poor Fair Good Excellent
How did staff treat you?
Did staff do what they said they would do?
Did staff assist you in a timely manner?
How was your overall service experience?

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* 5. Are there other types of assistance or services which you are seeking that the agency did not provide?

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* 6. If yes, please describe what the assistance or services are in the space below:

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* 7. Do you have any recommendations to improve how clients are served?

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