Client and Guardian Satisfaction Survey

Question Title

* 1. I am a Client or Guardian?

I am a Client

I am a Guardian

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* 2. I received a client/guardian handbook?

Yes

No

N/A

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* 3. I participate in choosing my care provider?

Yes

No

N/A

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* 4. I know my client rights & responsibilities?

Yes

No

N/A

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* 5. I participate in developing my personal centered plan?

Yes

No

N/A

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* 6. The agency treats me with dignity & respect?

Yes

No

N/A

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* 7. I have the opportunity to make choices for myself at the agency?

Yes

No

N/A

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* 8. Overall, I am pleased with the support I receive from agency?

Yes

No

N/A

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* 9. I know how to voice my concerns at the agency?

Yes

No

N/A

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* 10. Would you recommend this agency as a great place to receive services?

Yes

No

N/A

Question Title

* 11. I have received services from the agency for?

< 1 year

1-5 years

> 5 years