Quality Assurance

Please answer the following questions as honestly as possible. Please provide your comments at the end of this survey as it relates to your needs. Thank You.

Quality of Service
  1. The overall service that I received from my Staff within the last year has been:
  2. The quality of services provided by the staff is:
  3. My staff treats me with respect and courtesy.
  4. My staff returns my phone calls promptly and answers all questions that I have.
  5. My staff listens to my needs.
  6. There were no communication or physical barriers to receiving services.
  7. My staff shares all relevant information about services available in the community.
  8. My staff asks me for my ideas and choices when planning activities.
  9. My staff provides me the opportunity to learn about my options in planning my goals.
  10. My staff respects my rights as an individual and keeps information confidential.
  11. My staff assist me in maintaining a personal network of family and friends in order to increase my social interaction skills.
  12. My staff knows the goals stated on my ILS Plan of Instruction.
  13. My staff returns my calls in a timely manner.
  14. My staff comes to appointments and meetings on time and comes prepared.
  15. My staff encourages me to make my own choices and gives me the information I need to make those choices.
  16. My staff seems to be sensitive to my culture.
  17. My staff listens carefully to my concerns and seems to understand me.
  18. On average, How many hours per SESSION does your staff spend with you?
  19. On Average, how many times per week does your staff visit with you?
  20. My Staff treats my peers with respect and dignity.
  21. My Staff has a positive attitude.
  22. My Staff allows me access to my reports and consents.
  23. My Staff helps me learn to take care of myself.
  24. My Staff helps me with emergencies.
  25. My Staff helps me get to appointments when needed.
  26. My Staff helps me solve my problems or concerns.
  27. Administration responds to my concerns and needs.
Satisfaction Rating
  • Please check the box that indicates whether you are satisfied with and would like to continue working with your staff.
My Comments
  • My Comments are as follows:
Contact Information

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