Family Feedback/Satisfaction Survey Please enable JavaScript in your browser to complete this form.1) What is the member's sex?MaleFemale2) Which of the following describes your race or ethnic background?African AmericaHispanicNative AmericanCaucasian/White3) How long have you participated in the program?Less than a year1 to 2 years3 years+4) How many times in a month do you participate in program activities (attend events or classes)?5 times or less6-10 times11 times or more5) How many times in a month do you talk with program staff/administrators (phone conversations, home visits, or program activities)?5 times or less6-10 times11 times or moreOthers (Specifiy)1. How would rate overall appearance and location of our facilities?123452. How would rate the quality of care giving by our staff/providers?123453. How would rate knowledge and skills of our providers?123454. How would rate our providers willingness to listen /talk with you?123455. How would rate the politeness of our administrative and office staff?123456. How would rate members’ safety?123457. How would rate our planned and organized activities and program?123458. How would rate the improvement of members’ social & communication skills by participation in the program?123459. How would you rate respect of cultural differences at the program?1234510. How would rate the overall satisfaction with the services provided?12345Comments:Submit
