Date of Visit

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* 1. Date of Visit

Did you receive the assistance you requested?

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* 2. Did you receive the assistance you requested?

If you were not provided with assistance, were you referred to another agency for assistance?

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* 3. If you were not provided with assistance, were you referred to another agency for assistance?

The person who assisted me was knowledgeable about services?

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* 4. The person who assisted me was knowledgeable about services?

I was assisted with more than what I came in for?

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* 5. I was assisted with more than what I came in for?

I was treated with respect during my visit?

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* 6. I was treated with respect during my visit?

Would you refer a friend or family member to CCAP?

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* 7. Would you refer a friend or family member to CCAP?

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