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* 1. Date and time of call/contact with The Arc of Somerset County:

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Time

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* 2. Please enter the name of The Arc of Somerset County employee or the name of the Department with whom you had contact:

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* 3. Did you receive the information or resources that you inquired about?

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* 4. Was your concern handled in a prompt, efficient and professional manner?

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* 5. If you had a concern or issue, has it been resolved?

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* 6. Would you like us to inform the Board of Directors of your concern?

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* 7. To improve our services and enhance quality assurance, would you please share your experience with us? We would like to know for example: what was successful; what can we do to improve; where there any obstacles; are you satisfied?; etc.? 

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* 8. Would you like to provide us with general feedback?

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* 9. Our Mission is to provide quality services and advocacy for our individuals and their families; do you feel that our employees demonstrate our mission on a regular basis?

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* 10. Please indicate your affiliation with The Arc of Somerset County:

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* 11. If you would like us to contact you or if you would like more information about our services, please leave us your information:

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