Satisfaction Survey

Cornerstone prides itself on providing quality services and your feedback is integral to our continued growth and care. We appreciate your time in completing this survey.

Individual Supported:*

Behavior SupportHousing TransitionSupported LivingGroup Home

Questions:*

Rows	N/A	Does Not Meet Expectations	Meets Expectations	Exceeds Expectations
1. Cornerstone consistently attends scheduled appointments/meetings and is timely
2. Cornerstone maintains regular communication with individual/others
3. Cornerstone is a team player, listens to individual/team needs and works to find solutions
4. Cornerstone is responsive when concerns arise and assists with problem solving in a timely manner
5. Cornerstone supports and/or develops appropriate goals/strategies to target identified needs
6. Cornerstone interacts professionally in attitude and demeanor
7. Needs are individualized to the person and meet the appropriate level of care
8. Reports and documents are easy to understand and provide information on progress and regression
9. The individual/team is benefitting from Cornerstone services
10. I know who to contact at Cornerstone and how to contact them if I have a problem
11. The Cornerstone Agency provides quality services to individuals
12. Cornerstone provides clear information on their responsibilities and role/s

YesNo

Comments:

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Name:*

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Title/Relationship:

Date: *