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WABASHA COUNTY SOCIAL SERVICES
Income Maintenance Unit
*
1.
In my most recent contact with the agency:
(Required.)
I visited the office.
I made a phone call.
I sent a letter, fax, or email.
I had another form of communication with the office.
Other (please specify)
2.
My reason for contacting the agency was related to:
Applying for cash, food or health care.
Reporting a change.
A letter I received.
None of the above
Other (please specify)
3.
Please rate the following about the
STAFF
you interacted with at our agency:
Strongly Agree
Agree
Disagree
Strongly Disagree
Had the knowledge to handle my request.
Strongly Agree
Agree
Disagree
Strongly Disagree
Listened to my issues/question carefully.
Strongly Agree
Agree
Disagree
Strongly Disagree
Handled my issue/question professionaly.
Strongly Agree
Agree
Disagree
Strongly Disagree
Provided valuable solutions to meet my need.
Strongly Agree
Agree
Disagree
Strongly Disagree
Explained how the issue would be resolved.
Strongly Agree
Agree
Disagree
Strongly Disagree
Responded to me in a timely manner.
Strongly Agree
Agree
Disagree
Strongly Disagree
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4.
Agency Staff helped me resolve my issues/question.
(Required.)
Yes
No
Don't know
Other (please specify)
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5.
I contacted the agency about the same issue/question:
(Required.)
Once
Twice
Three times
Four times
More than four times
Other (please specify)
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6.
For the following statements, please rate your
overall service at our agency:
(Required.)
Strongly agree
Agree
Disagree
Strongly Disagree
N/A
I get timely support from this agency.
Strongly agree
Agree
Disagree
Strongly Disagree
N/A
This agency works for my best interest.
Strongly agree
Agree
Disagree
Strongly Disagree
N/A
I trust this agency.
Strongly agree
Agree
Disagree
Strongly Disagree
N/A
Other (please specify)
7.
Please add any other comments, suggestions or feedback you would like to share with our agency.
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