Customer Satisfaction Survey Question Title * 1. Which location did you visit today? Talladega Sylacauga Roanoke Wedowee Anniston Piedmont Lineville Heflin Question Title * 2. What is your gender? Female Male Question Title * 3. Which race/ethnicity best describes you? (Please choose only one.) American Indian or Alaskan Native Asian / Pacific Islander Black / African American Hispanic White / Caucasian Multiple ethnicity / Other (please specify) Question Title * 4. What is your age? 18-24 25-44 45-54 55-59 60 or older Question Title * 5. How did you find about the services offered by CAA? Newspaper Radio Internet/Social Media Family Member Other Question Title * 6. Have you received services from CAA in the past 5 years? Yes No Question Title * 7. Were you referred to other agencies for services? Yes No Question Title * 8. Do you feel that you were treated with courtesy and respect? Yes No Question Title * 9. Did you get the type of service(s) expected? Yes No Question Title * 10. How long did you wait before someone assisted you? 0-15 minutes 15-30 minutes 30-45 minutes 45+ minutes Question Title * 11. What type of assistance did you receive today? Weatherization Power Rent/Shelter Referral Nutrition Transportation Propane Water Question Title * 12. Overall, how would you rate the service you received from the staff at our office? Excellent Very good Good Fair Poor Done
