Provider Feedback
1.
What type of provider did you have?
Agency
Independent
2.
What was your overall level of satisfaction with this provider?
Very dissatisfied
1 star
Dissatisfied
2 stars
Neutral
3 stars
Satisfied
4 stars
Very satisfied
5 stars
3.
How long was this provider working with you?
Less than six months
Six months to one year
One year to five years
Five years or more
4.
Was this provider reliable?
Yes
No
Please explain
5.
Were this provider's services person centered?
Yes
No
6.
Do you have any additional feedback and/or comments you would like to share?