Social Services would love to hear your opinion!

This survey is anonymous and your answers will not impact your services. 

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* 1. Today's Date (MM/DD/YYYY):

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* 2. Your Age

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* 3. Program

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* 4. Background Information

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* 5. Race/Ethnicity (Check all that apply)

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* 6. Please select your level of agreement with each of the following statements about the service you received.

  Strongly Disagree Disagree Agree Strongly Agree N/A
The meeting place was convenient
The meeting place was comfortable
I got connected to the services I was seeking
I was treated with respect
My questions were answered
I am satisfied with the service I received
Staff were sensitive to my cultural/ethnic background

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* 7. What did you like best about the services you received?

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* 8. How can we improve our services?

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* 9. Does your household have any unmet needs?

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* 10. If you would like a response, please provide your name (first and last) and contact information (Email and/or Phone). We will respond within 10 business days.

Options to submit feedback: Social Services or Veteran Services lobby drop box, fax 503-650-5722, email socialservicefeedback@clackamas.us, or mail to Social Service Feedback, P.O. Box 2950, Oregon City, OR 97045

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