Customer Satisfaction Survey

This survey may be completed by an individual receiving services at Region Ten Community Services Board and/or an individual’s authorized representative or legal guardian.

This survey is voluntary, and program services will not be affected by whether or not you complete this survey.

Answers to this survey are confidential and will not be linked to you or affect participation in any programs.

Please answer the following questions based on the last 6 months OR if you have not received services for 6 months, please give answers on the services you have received so far.

Indicate if you Strongly Agree, Agree, are Neutral, Disagree or Strongly Disagree with each of the statements below:

Statements

If I had other choices of providers, I would still choose this agency for my services.(Required)

I would recommend this agency to a friend or family member.(Required)

I feel helped by the services I get here.(Required)

Region Ten staff respond when I reach out.(Required)

Region Ten staff believe that I can grow, change, and recover.(Required)

Region Ten staff help empower me in how I want to live my life.(Required)

Region Ten staff are sensitive to my cultural background (race, religion, language, age, communication, etc.)(Required)

As a direct result of the services I have received, I deal more effectively with daily problems.(Required)

Comment Boxes

Are you a Region Ten consumer?(Required)

Yes

How are you affiliated with Region Ten?(Required)

Which service(s) do you receive?

What do you like best about the services you are currently receiving?

If you could change one thing about your service at Region Ten CSB, what would it be?

Additional Comments?

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