Contact - photoClient Satisfaction Survey

We would appreciate your feedback regarding your experience with us. Please take a few moments to answer the following questions. Your response will help in our efforts to provide the very best services possible. Thank you.
Please tell us the name of the program with which you are/were involved:
During what time period did you receive services:
From: To:
Part I. Directions
Use the following scale to rate your experience with Y.O.U. Inc.

Strongly Agree - Agree - Disagree - Strogly Disagree - Not Applicable
1. Overall, the staff are sensitive and responsive to my needs.
2. Staff are respectful of my cultural and ethnic needs.
3. Staff are trying to help me with my problems/issues.
4. The staff at intake were helpful.
5. The facility my program was in was clean and neat.
6. I would recommend Y.O.U., Inc. to someone I know.
7. Overall, I am satisfied with my experience with Y.O.U., Inc.
Part II. Directions
Please let us know what you think our areas of strengths are, as well as areas for improvements, by commenting in the sections below.
Areas of Strengths:
Areas for Improvement
If you would like to be contacted by the Y.O.U., Inc. Quality Management Department please complete the following information.
Name
 Telephone