Client Satisfaction Survey
Date
/
Month
/
Day
Year
Date
VR Counselor:
*
Please Select
Gena Brockhaus
Jana Finkbonner
Sandy Gotts
Tammy Cooper-Woodrich
Status of my case:
My Case is Currently, Open
My Case is Currently, Closed
Was the VR process easy to understand?
Yes
No
Not Sure
If No, please explain:
Has NIVRP helped you to understand your disability better?
Yes
No
Not Sure
If No, please explain:
Have we been responsive to your questions and/or concerns about VR:
Yes
No
Not Sure
If No, please explain:
It is our goal to provide a VR program that meets the needs of your community. Do you have any suggestions of how we might do this better?
Yes
No
Not Sure
If yes, please explain:
Please rate your level of satisfaction with the program, 5 being completely satisfied and 1 being dissatisfied. Please circle one:
1
2
3
4
5
Thank You, for taking the time to complete this survey!!!!!
Main Office: 3201 Northwest Avenue #8, Bellingham, WA 98225
Phone: 360-671-7626, Fax: 360-733-3061
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