Consumer Satisfaction Survey
Date Returned
MM
/
DD
/
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ID Number
Assigned by staff
Your answer
County of Residence
What services did you receive from Disability Rights and Resources?
1. Services were provided in a timely manner
2. Staff treated me with respect
3. I was given choices and options
4. Staff gave me useful information
5. The person I worked with listened to my needs.
6. Overall, I would rate the services:
7. Do you think you've gained any new skills, knowledge, or resources you didn't have when you first started working with DRR?
If yes, what specific skills, knowledge, or resources have you gained that you didn't have before?
Your answer
8. Do you think you've become more independent than you were when you first started working with DRR?
If yes, how specifically are you more independent than you were before?
Your answer
9. How did you hear about us?
Your answer
10. What can be done to improve our services?
Your answer
11. What are the top 3 problems you see that face people with dabilities
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