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* 1. Please indicate your affiliation with Capitol Care:

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* 2. Please check the program(s) provided by Capitol Care that you are involved with:

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* 3. Do you feel our staff conduct themselves in a professional manner?

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* 4. Are you satisfied or dissatisfied with Capitol Care's facilities?

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* 5. When you contact the Agency, are you clearly directed to the person with whom you need to speak to either by automatic prompts or by front desk personnel?

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* 6. When you contact the Agency, is your call responded to appropriately and within a timely fashion?

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* 7. Do our transportation services meet your needs?

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* 8. When you made a referral to our Agency services, were you satisfied with our intake process?

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* 9. Do you have any further recommendations for our agency?

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* 10. Do you feel Capitol Care values Cultural Diversity?

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