10/02/2007 Satisfaction Survey
 

 

 

 

 

   In an effort to improve our programs and services, your candid input is valuable.  Please help us identify our strengths and weaknesses by completing this evaluation.

 

 

 

Which program do you want to rate?

Other:

 

What is your relationship to the program?

Other:

 

Have contacts with this program been positive and productive?

 

Have phone calls been returned promptly?

 

Have your concerns been dealt with in a timely manner?

 

Is professionalism evident?

 

Do you observe consumers to be treated with respect?

 

Is paperwork completed in a timely manner?

 

Overall, my attitude toward this program is:

 

Suggestions for improvement:

 

 

Enter your additional comments in the space provided below:

 

Tell us how to get in touch with you:

Name
E-mail
Tel
FAX
 
Please contact me as soon as possible regarding this matter.
 

  
   
 

 

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