Physical Disability Services Satisfaction Survey Logging
Survey
Date:
First Name:
*
Last Name:
*
Phone Number:
Area Delevopment District:
*
County:
*
1. When you contacted the Aging and Disability Resource Center, did you speak with a live person?
If No, did you leave a voicemail?
If Yes, when was your call returned?


Comments:

2. Were they able to assist you and provide you with information on how to apply for services?
Comments:

3. Have you been assigned a case-manager? (If No, skip to question #11)
*
Comments:

4. Do you know how to contact your case-manager if you have questions or need help?
Comments:

5. Have you had any issues reaching your case-manager and does he/she follow up with your requests and needs?
Comments:

6. Has your case-manager helped you find additional services or help that you need?
Comments:

7. Has your case manager provided documents containing the address, phone number, and contact person for the local Area Agency on Aging?
Comments:

8. Overall, how satisfied are you with your case-manager?




Comments:

9. Have you tried to contact the agency directly?
If yes, were you able to speak to a live person?
If No, did you leave a voicemail?
If Yes, when was your phone call returned?


Comments:
10. How satisfied are you with your services through the agency?




Comments:
11. Do you receive meals at the senior center or home delivered meals? (If No, skip to question #15)
Comments:
12. Are the meals presented in an appealing manner?




Comments:
13. Are you satisfied with the flavor of the food?




Comments:
14. Are you satisfied with the variety of food offered throughout the month?




Comments:

15. Do you have any additional comments, complaints, or concerns that I have not covered?
Admin
DAIL Staff:
Comments:
 
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