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FY23 ADRC Client Satisfaction Survey
KIPDA strives to ensure that we are providing quality resources and assistance to the community. We want your input about your experience with the Aging & Disability Resource Center (ADRC). Thank you!
1.
What is your age?
Under 17 years old
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65-74 years old
75 years or older
2.
What is your gender?
Female
Male
Other
3.
Which race/ethnicity best describes you? (Please choose only one.)
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Other (please specify)
4.
What was the name of the ADRC Specialist that assisted you?
Lisa
Shelia
Shantrece
Brittney
Other (please specify)
5.
How did you first hear about the Aging & Disability Resource Center?
Friend, Neighbor, Relative
Physician or Hospital
Home Health Agency
Newspaper/ Newsletter
Radio
Resource Fair
Website
Brochure, Flyer, Business Card
Other (please specify)
6.
How long did you wait to hear from someone after contacting the ADRC office?
Same day
Next day
3-5 days
Longer than 5 days
7.
What was the main reason you contacted the ADRC?
Caregiver information
Help in the home
Transportation
Medicare Benefits (SHIP)
Housing Options
Medicaid Wavier Services
Community Resources
Other (please specify)
8.
Do you feel the ADRC Specialist you spoke with...
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Listened carefully to what you wanted?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Understood what you wanted?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Explained things to you in a way that you can understand?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Was knowledgeable about the services and information you asked about?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Was courteous and respectful?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
9.
Overall
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Was the information you received clear?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Was the information you received helpful?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
Would you call the KIPDA ADRC again in the future?
No, I don't think so
I'm not sure, I still have questions
Yes, I think so
