* 1. What was the nature of your visit or contact with York/Poquoson Social Services?

* 2. Was your contact:

* 3. Were you seen in a timely manner?

* 4. Does staff clearly explain what programs and services are available?

* 5. Does staff explain what the agency can do to assist you?

* 6. My case worker listens to my concerns and understands my needs:

* 7. Do you sense your information is kept private?

* 8. Was the receptionist courteous?

* 9. Do we return your telephone calls in a timely manner?

* 10. Did we see you on time for your appointments?

* 11. When my caseworker says she/he will do something, she/he does it:

* 12. My caseworker is encouraging and helps me succeed:

* 13. Did we complete your case on time?

* 14. How would you rate your overall experience with York/Poquoson Social Services?

* 15. Your Name (optional):

* 16. Your telephone number (optional):

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