*1.In which county do you live?(Required.)

Breathitt

Lee

Owsley

Wolfe

*2.Staff was knowledgeable.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*3.Staff was courteous, respectful and sensitive to your situation.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*4.Staff was patient and took time to understand my situation.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*5.Staff answered questions and took an interest in you.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*6.Facilities were clean.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*7.You were comfortable during your visit.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*8.You were able to find our agency location easily.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great

*9.How did you hear about our agency?(Required.)

Newspaper

Radio

Television

Social Media

Family/Friend

Other (please specify)

*10.Overall rating of agency.(Required.)

1 - Poor Services (Needs Immediate Improvement)

2 - Poor to Average (Needs Improvement)

3 - Average

4 - Above Average

5 - Great