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CUSTOMER SATISFACTION SURVEY

Welcome to the Imagine! web-based customer satisfaction survey. Thank you for taking time to give us your feedback.

In an effort to ensure that Imagine! is providing quality services that meet the needs of our customers, we are asking for feedback regarding your experiences with us.

How to use this survey:
Look at the categories listed and determine which category fits the description for the feedback you would like to provide. You may answer any or all questions that you would like. There is space within each category for additional comments.  You may either scroll down the page and fill out questions as you go, or you may click on any category in the SURVEY SECTIONS list to go directly to the category you wish.

After you are done, press the “SUBMIT” button at the bottom of the form, and the information will be sent directly to the Quality Assurance Department at Imagine!. The information remains anonymous unless you choose to provide name and contact information.


SURVEY SECTIONS LIST

General/Welcome
Case Management
Individualized Plan (IP) / Service Plan (SP)
My Services
Contact Information (Optional)

 


GENERAL / WELCOME

From the time you enter the doors at Imagine! we want you to feel welcome and comfortable. Please let us know how we are doing in this regard.

1. Did someone greet you upon arrival in the building? Yes  No

2. Was staff courteous and friendly? Yes   No

3. Did your appointment begin on time?  

4. Did you find the waiting area comfortable?  
If no, what would make it more comfortable?

5. Did the person with whom you were meeting come to the lobby to show
you to the correct office or meeting room?

6. Overall did you feel welcome and comfortable?

Comments:

Back to the Survey Sections list                                   To the SUBMIT button

 

CASE MANAGEMENT

At Imagine! we recognize that case managers are the backbone of service coordination. In order to continue to respond effectively and efficiently to your needs, we appreciate your responses to the following questions.

1. Do you know the name of your case manager? Yes 

2. Do you know how to contact your case manager?  

3. Do you feel comfortable contacting your case manager? Yes  No

4. Do you see your case manager on a regular basis? Yes  No

5. Is your case manager knowledgeable about services and supports? Yes  No

Comments:

Back to the Survey Sections list                                   To the SUBMIT button

 

INDIVIDUALIZED PLAN (IP) / SERVICE PLAN (SP)

As a Community Centered Board (CCB) we at Imagine! are required to follow guidelines set by the state in developing an Individualized Plan (IP) / Service Plan (SP). Although there are requirements we are unable to change, we wish to make the process as easy and understandable as possible. Thank you for giving your feedback in regard to the individual plan/service plan process.

1. Was the purpose of the IP/SP meeting clear to you? Yes  No

2. Was there enough time for the meeting? Yes  No

3. Were all the individual’s needs discussed? Yes  No

4. Did everyone have an opportunity to give input? Yes  No

5. Did you feel comfortable sharing your opinion? Yes  No

6. Were your questions answered? Yes  No

Comments:

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MY SERVICES

As service providers in the developmental disabilities system we are required to follow rules and guidelines set by the state in the provision of services. Although we are unable to change the requirements, we wish to work together to provide services for improved quality of life for individuals and families. Thank you for your response to the following questions to let us know how we are doing in that regard.

Residential

Name of Provider Organization: 

1. Do the services meet your needs?  Yes  No

2. Are you satisfied with the supports you are receiving?  Yes  No 

3. Do you have choices about services and supports?  Yes  No 

4. Does the program respond to your questions or concerns?  Yes  No 

Comments:


Day Program

Name of Provider Organization: 

1. Do the services meet your needs?  Yes  No

2. Are you satisfied with the supports you are receiving?  Yes  No 

3. Do you have choices about services and supports?  Yes  No 

4. Does the program respond to your questions or concerns?  Yes  No 

Comments:


Supported Living Services (SLS)

Name of Provider Organization: 

1. Do the services meet your needs?  Yes  No

2. Are you satisfied with the supports you are receiving?  Yes  No 

3. Do you have choices about services and supports?  Yes  No 

4. Does the program respond to your questions or concerns?  Yes  No 

Comments:


Work Services

Name of Provider Organization: 

1. Do the services meet your needs?  Yes  No

2. Are you satisfied with the supports you are receiving?  Yes  No 

3. Do you have choices about services and supports?  Yes  No 

4. Does the program respond to your questions or concerns?  Yes  No 

Comments:


Family Services

Name of Provider Organization: 

1. Do the services meet your needs?  Yes  No

2. Are you satisfied with the supports you are receiving?  Yes  No 

3. Do you have choices about services and supports?  Yes  No 

4. Does the program respond to your questions or concerns?  Yes  No 

Comments:

Back to the Survey Sections list                                   To the SUBMIT button

 

CONTACT INFORMATION (OPTIONAL)

This section is optional.

Your full name: 

If you wish to be contacted for follow-up, please enter information below:

Full address:

Phone: 

Alternate phone: 

Email: 

Thank you for taking the time to fill out this survey.

Please Check the box below.