CONSUMER SATISFACTION SURVEY

Our consumers are important to us. Our goal is to provide services that will strengthen the capacity of people with disabilities to be more self-sufficient in the community. To this end, we are requesting your help to improve our services to people with disabilities. Please take the time to answer the following questions. All answers will remain confidential. Thank you.

 

Name *
Name
PART 1
What types of service areas did you find most helpful? *
Check all areas that apply.
What types of service areas did you find least helpful? *
Check all areas that apply.
Did you receive the assistance you requested? *
Are you satisfied with the services you requested? *
PART 2
Please rate the following statements. *
Please rate the following statements.
Communication of the reception staff was effective.
Services were provided in a timely manner.
The staff treated me with respect.
Information was provided to me in an accessible manner.
I gained new knowledge from working with ACI.
I learned new skills while working with ACI.
I was included in the development of my Independent Living Plan or setting goals, outcomes or objectives.
My situation changed and improved while working with ACI.
ACI has given me a greater feeling of independence and the ability to control my own life and make my own decisions.
ACI makes me feel safe. I feel like I can be myself and feel comfortable talking with staff, even about difficult subjects.
PART 3
PART 4