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Assistive Technology of Ohio Customer Survey (2018-2019)
Please help us improve our services by taking this important (and brief) survey... Thank you!
* Required
What is your name?
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Your answer
Which device did you borrow?
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Your answer
What was the purpose of the device?
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Please indicate the reason which best applies
To assist in decision making (device trial or evaluation)
To serve as a loaner device during repair or while waiting for funding
To provide an accommodation on a short-term basis
Other:
Required
Which category best describes the person who borrowed the device?
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Please indicate the description which best applies
Individual with disabilities
Family members, guardians, and authorized representatives
Representatives of education
Representatives of employment
Representatives of health, allied health, and rehabilitation
Representatives of community living
Representatives of Technology
Other:
Required
Which description of need best applies to your situation?
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Please indicate the description which best applies
A.T. primarily needed for education
A.T. primarily needed for employment
A.T. primarily needed for community living
A.T. primarily needed for I.T. / telecommunications
Required
Which of the following best describes your decision regarding the device?
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I decided the device / equipment will meet my needs
I decided that the device / equipment will not meet my needs
I have not made a decision
Required
How would you rate your level of customer satisfaction?
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Please indicate the description which best applies
Choose
Highly satisfied
Satisfied
Somewhat satisfied
Not at all satisfied
Please let us know how this service has helped you by telling us about your specific situation. (optional)
Let us know how this device will impact your life. (begin typing in box below)
Your answer
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