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* 1. Please indicate the services you now receive or have received in the past from Disability Connections.  Check all that apply.

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* 2. Disability Connections' Staff treated you in a friendly, caring and respectful manner.

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* 3. Disability Connections' services were provided in a timely manner.

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* 4. Disability Connections' Staff encouraged you to make decisions so you can live more independently.

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* 5. Disability Connections' services met your needs.

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* 6. Disability Connections' services gave you enough information to make informed decisions.

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* 7. I am satisfied with services provided by Disability Connections.

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* 8. Optional - Based on your experience, what could the Center do to improve services?

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* 9. Optional - Please provide the name(s) of Disability Connections' staff who assisted you with services.

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* 10. Optional - Please enter your contact information.

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