Member Service-Evaluation Form

Member Service-Evaluation Form

Kindness Initiative strives for continual improvement of our performance and that of our Service Provider partners, through feedback from our Members. Accordingly we request that Members routinely submit online performance evaluation sheets. THANK YOU!
Name of Case Manager*
Names of Service Providers you were referred to: *
Please make selections: How satisfied are you with the service you received at Kindness Initiative, overall?

Very SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied
Would you use the service providers you were referred to again in the future?

DefinitelyProbablyNot SureProbably NotDefinitely Not
Would you recommend Kindness Initiative to others?

DefinitelyProbablyNot SureProbably NotDefinitely Not
What do you like most about the services you received from Kindness Initiative?

Treated with respect, kindness and compassionWarm greeting and pleasant goodbyePromptness and responsive to my calls and questionsAddressed and resolved my need(s)Needs not resolved but alternative recommendations madeProtected my privacy and confidential informationNone of the above
Do you have any questions or comments? We'd be more than happy to hear them!*
Name*

First NameLast Name
E-mail*
example@example.com
Should be Empty: