Survey

Satisfaction Survey

Thank you for completing this survey. This information will be used to improve our business practices.
Whats your title? *
Which type of service do you currently receive?*

Non-Medical TransportationHPC ( Home and Personal Care)Community InclusionTransportationAdult DayVocationalTripsPartnerships
Is there anything that you want to change about your current services?

YesNoMaybe

Are you happy with the services that you receive from Different Abilities? *

	1	2	3	4	5	6	7	8	9	10

1 is Terrible , 10 is Fantastic

Are you satisfied with scheduling?*

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Fantastic

Does Different Abilities keep good communication with you?*

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Fantastic

Are Different Abilities employees Professional?*

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Fantastic

Are you happy with your Direct Service Provider?*

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Fantastic

Are Different Abilities employees on their cell phones during services?*

YesSometimesNoOther
Would you recommend Different Abilities to others?*

Yes, definitelyMaybe,No, never

How would you rate the attitude of the employee providing your service? *

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Great

How would you rate the professionalism of the employee providing your service? *

	1	2	3	4	5	6	7	8	9	10

1 is Terrible, 10 is Great

Are you having issues with an employee or individual at your site?*

YesNoMaybeOther
Please Explain, if you checked Yes or Maybe to the above question.
What are strengths of Different Abilities ?*
What are weakness of Different Abilities ?*
What would you like to see changed? *
Any final comments?
Your Name (Optional)

First NameLast Name
E-mail (Optional)
Phone Number (Optional)

Area CodePhone Number
Should be Empty:

Satisfaction Survey