Instructions:

We are Conducting this survey as part of our continuous quality improvement process and would appreciate your feedback on satisfaction with our services in the past year.  Your answers will remain confidential. The information you provide will be used in planning services. Your participation is completely voluntary, but greatly appreciated.

Rating Scale:
 
Very Satisfied: Please use this category to indicate performance that is above your expectations.
 
Satisfied: Please use this category to indicate performance that is consistent with your expectations.
 
Not Satisfied: Please use this category to indicate performance that is below your expectations.
 
No Basis to Rate: Please use this category if you have no information or experience to rate performance.

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