Consumer Satisfaction Survey
CID values and appreciates your participation in this voluntary survey. Your feedback will be used to improve and enhance our programs. No personal identifying information is required. Thank you.
Please check all responses that apply.
1. Are you:
A person with a disability
A family member of a person with a disability
A friend of a person with a disability
A service provider
2a How did you find out about CID?
Friend or family member
Case or Social Worker
Outreach or presentation
2b. If you selected another agency or newsletter, which one did you hear about CID from?
3. When you contacted CID for assistance, staff responded
Within 24 hours
Within 2 business days
Within 3-5 business days
5 days or more
4. After contacting CID, did you receive any of the following services?
Home Accessibility Modification
Independent Living Skills
Independent Living Planning & Support
Information and Referral
Personal Assistance Program
Transition from Nursing Facility
Work Incentive Planning and Assistance (WIPA)
4A. Do you feel the services you received helped you to increase your independence?
5. After contacting CID, did you receive any of the following information on:
The voting process
Health care services
5A. Do you feel the information helped you to increase your independence?
6. Did CID staff treat you with respect and was staff sensitive to your disability?
7. Overall, were you satisfied with the service(s) you received and would you refer someone to CID in the future?
8. As a result of your interactions with CID, have you participated in any disability-related advocacy or educational activities?
8A. If "yes", select all of the topics or issues that apply:
9. With regard to the services or assistance you obtained from CID, were your disability-related accommodation needs met?
9A. If "NO," please explain:
10. With regard to the services or assistance you obtained from CID, were your language translation needs met?
10A. If no, please explain:
Is there anything else that you would like for us to know about your experience with CID?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service