Satisfaction Survey
Thank you for completing this survey. This information will be used to improve our business practices.
Whats your title?
*
Please Select
Client
Parent/Guardian
SSA
Friend
Other
Which type of service do you currently receive?
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Non-Medical Transportation
HPC ( Home and Personal Care)
Community Inclusion
Transportation
Adult Day
Vocational
Trips
Partnerships
Is there anything that you want to change about your current services?
Yes
No
Maybe
Are you happy with the services that you receive from Different Abilities?
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1
2
3
4
5
6
7
8
9
10
Terrible
Fantastic
1 is Terrible , 10 is Fantastic
Are you satisfied with scheduling?
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1
2
3
4
5
6
7
8
9
10
Terrible
Fantastic
1 is Terrible, 10 is Fantastic
Does Different Abilities keep good communication with you?
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1
2
3
4
5
6
7
8
9
10
Terrible
Fantastic
1 is Terrible, 10 is Fantastic
Are Different Abilities employees Professional?
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1
2
3
4
5
6
7
8
9
10
Terrible
Fantastic
1 is Terrible, 10 is Fantastic
Are you happy with your Direct Service Provider?
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1
2
3
4
5
6
7
8
9
10
Terrible
Fantastic
1 is Terrible, 10 is Fantastic
Are Different Abilities employees on their cell phones during services?
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Yes
Sometimes
No
Other
Would you recommend Different Abilities to others?
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Yes, definitely
Maybe,
No, never
How would you rate the attitude of the employee providing your service?
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1
2
3
4
5
6
7
8
9
10
Terrible
Great
1 is Terrible, 10 is Great
How would you rate the professionalism of the employee providing your service?
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1
2
3
4
5
6
7
8
9
10
Terrible
Great
1 is Terrible, 10 is Great
Are you having issues with an employee or individual at your site?
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Yes
No
Maybe
Other
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 Name
Last Name
E-mail (Optional)
Phone Number (Optional)
-
Area Code
Phone Number
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