ADRC Satisfaction Survey

Aging and Disability Resource Connection (ADRC) of Oregon Satisfaction Survey

This is a monthly survey sent or made available online to participants of CAPECO's ADRC clients to gather input about their level of satisfaction with services offered and rendered through the program.
Date:*

MonthDayYear
Email - Please share your contact email address.*

Confirmation EmailPlease type your e-mail address twice for security.
We appreciate hearing your valuable input. Please continue, to complete this survey.
1. Why did you call ADRC (what were you looking for)?*
Please explain in as much or little detail as you choose.
2. Did you get the information you needed (select one)?*

YesNo
3. Please rate the quality of your interaction with CAPECO staff, from 1 to 4, with 1 = not at all friendly or helpful, 2 = Somewhat friendly or helpful, 3 = Friendly or helpful or 4 = Very friendly and helpful. Select one option below to indicate your staff interaction quality score.*

1 = Not at all friendly or helpful2 = Somewhat friendly or helpful3 = Friendly or helpful4 = Very friendly or helpful
4. Rate the ease of using ADRC (1 to 4, not at all easy to use, to very easy to use) Select one option below.*

1 = Not at all easy to use2 = Somewhat easy to use3 = Easy to use4 = Very easy to use
5. Was the ADRC call line answered by a person (choose one)?*

YesNo
6. Did you leave a voice mail (choose one)?*

YesNo
7. If you left a voice mail, rate your experience in their calling you back (1 to 4, from 1. took too long to call back, to 4. called back sooner than expected).

1. Took too long to call back2. Took a little longer than expected to call back3. Took the normal expected time to call back4. Called back sooner than expected
8. Would you recommend calling ADRC to friends and family? Select response below.*

YesNo
More details about why you would or would not recommend calling ADRC: If Yes, why? Please explain in as much or little detail as you choose. If No, why? Please explain in as much or little detail as you choose.*
9. Do you feel that the resources ADRC staff referred you to improved your physical health? Choose one below.*

YesNo
10. Do you feel that the resources ADRC staff referred you to improved your mental health? Choose one below.*

YesNo
11. If you are a person living with disabilities, do you feel that the resources ADRC staff referred you to allowed you to maintain an independent living situation? Choose one, below.

YesNoN/A
12. If you are a person living with chronic illness, do you feel that the resources ADRC staff referred you to allowed you to maintain an independent living situation? Choose one below.

YesNoN/A
13. Do you have any other comments you'd like to share with us about ADRC?
If you have questions or need assistance completing this survey, please call:

Main Office - 541-276-1926

Local ADRC Number - 855-673-2372, enter zip code when prompted

Thank you! Your responses will help us improve our services and will be used to shape future Area Plans to aid seniors.
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Aging and Disability Resource Connection (ADRC) of Oregon Satisfaction Survey