client satisfaction survey

Life Changes, Inc. P.O. Box 3137, Sparks, NV 89432 775.685.8145, LifeChangesInc@yahoo.com
Date

MonthDayYear
Date
Gender

MaleFemale
Facility
1. Staff treated me with kindness and respect.

1 - least satisfied2345 - most satisfied
2. Staff maintained professional conduct and standards.

1 - least satisfied2345 - most satisfied
3. Staff assisted me with referrals in a timely manner

1 - least satisfied2345 - most satisfied
4. Staff demonstrated a commitment toward my success

1 - least satisfied2345 - most satisfied
5. The building and facilities were wellmaintained.

1 - least satisfied2345 - most satisfied
6. The rules and expectations of Life Changes were clearly explained to me

1 - least satisfied2345 - most satisfied
7. I was provided additional resources when needed

1 - least satisfied2345 - most satisfied
8. I was able to accomplish my personal goals while at Life Changes.

1 - least satisfied2345 - most satisfied
9. I am satisfied with the tools I learned

1 - least satisfied2345 - most satisfied
10. I would recommend Life Changes to others

1 - least satisfied2345 - most satisfied
Additional Comments
LifeChanges/Forms/Client Satisfaction Survey
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