BLUE RIDGE COMMUNITY ACTION
Customer Satisfaction Survey
Name
First Name
Last Name
How did you find out about BRCA program(s)?
TV
Internet
Social Media
Family
Friend
Was the BRCA staff responsive to your inquiries?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Was the BRCA staff knowledgeable about the program you requested?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Which program did you recieve services from
*
Head Start
Early Head Start
Day Care
Adult Day Care
HARRP
Weatherization
Vita
Home Delivered Meals
Congerate Nutrirtion
Did you receive information about other services you may have been interested in?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Back
Next
Was the process, from application to receipt of services, easy to understand?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Did you receive the services for which you applied in the expected amount of time?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Would you recommend BRCA services to family or friends?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
Have the services you received impacted you and your family?
*
1
2
3
4
5
Strongly Disagree
Strongly Agree
1 is Strongly Disagree, 5 is Strongly Agree
How would you rate your overall interaction with BRCA?
*
1
2
3
4
5
Poor
Great
1 is Poor, 5 is Great
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