CENTRAL PIEDMONT COMMUNITY ACTION, INC.
CUSTOMER SATISFACTION SURVEY PY23-24
DATE
*
/
Month
/
Day
Year
Date
1. County of Residence?
*
Chatham
Orange
Randolph
Durham
2. How were you treated by the Agency staff?
*
Excellent
Very Good
Good
Fair
Poor
3. Were you treated with respect?
*
Yes
No
4. What service(s) / assistance were you seeking?
*
Resume
Job Search/Placement
Food
Utilities
Rent
Shelter/Homeless
Education
Referral
Weatherization
Other
5. What service(s) / assistance did you receive?
*
Resume
Job Search/Placement
Food
Utilities
Rent
Shelter/Homeless
Education
Referral
Weatherization
Other
6. Were you satisfied with the service(s) you received?
*
Yes
No
7. How would you rate the overall service(s) you received?
*
Excellent
Very Good
Good
Fair
Poor
8. How would you rate the quality and suitability of the service(s) and resources at the Agency?
*
Excellent
Very Good
Good
Fair
Poor
9. Overall, how would you rate the quality of your experience / relationship with the Agency?
*
Excellent
Very Good
Good
Fair
Poor
10. Would you recommend the services we provide?
*
Yes
No
If no, explain.
11 Other comments or suggestions on how we can improve our services.
Thank you for allowing us to serve you!
Submit
Should be Empty: