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DEVELOPMENTAL DISABILITIES FACT SHEETS
CAREER
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HOME
ABOUT US
SERVICES
PRIVACY
RESOURCES
MORE
DEVELOPMENTAL DISABILITIES
DEVELOPMENTAL DISABILITIES FACT SHEETS
CAREER
CONTACT US
SURVEY
Please fill out our brief Customer Satisfaction Survey. All of us at Exceptional Residential Services would like to thank you for using our services. We welcome your feedback regarding the care that you receive from us. Your honesty helps us work toward better service for everyone, while ensuring customer satisfaction.
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1. HOW LONG HAVE YOU USED OUR SERVICES?
*
LESS THAN A MONTH
1-12 MONTHS
1-3 YEARS
3-5 YEARS
MORE THAN 5 YEARS
2. WHICH SERVICES DO/DID YOU RECEIVE?
*
HOMEMAKER SERVICES
OTHER
3. HOW OFTEN DO/DID YOU RECEIVE OUR SERVICES?
*
2-4 HOURS PER DAY
5-8 HOURS PER DAY
17-24 HOURS PER DAY
OTHER
4. I AM SATISFIED WITH THE SERVICES I RECEIVE FROM INDEPENDENT RESIDENTIAL MANAGEMENT TRAINING.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
5. I AM SATISFIED WITH THE QUALITY OF THE SERVICES I RECEIVED.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
6. I FEEL THE STAFF MEMBERS WERE COMPETENT AND HAD THE SKILLS NECESSARY TO CARE FOR ME.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
7. I AM SATISFIED WITH INDEPENDENT RESIDENTIAL MANAGEMENT TRAINING'S STAFFING/SCHEDULING DEPARTMENT.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
8. I AM SATISFIED WITH THE ON-CALL SERVICES THAT ARE AVAILABLE AFTER HOURS.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
9. I AM SATISFIED WITH INDEPENDENT RESIDENTIAL MANAGEMENT TRAINING'S ADMINISTRATION DEPARTMENT.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
10. OVERALL, HOW WOULD YOU RATE INDEPENDENT RESIDENTIAL MANAGEMENT TRAINING'S SERVICES COMPARED TO OUR COMPETITORS?
*
MUCH BETTER
SOMEWHAT BETTER
SAME
SOMEWHAT WORSE
MUCH WORSE
NO OPINION
11. HOW SATISFIED ARE YOU WITH OUR SERVICES OVERALL?
*
EXTREMELY SATISFIED
QUITE SATISFIED
SOMEWHAT SATISFIED
NEUTRAL
SOMEWHAT DISSATISFIED
QUITE DISSATISFIED
EXTREMELY DISSATISFIED
12. I WOULD RECOMMEND INDEPENDENT RESIDENTIAL MANAGEMENT TRAINING'S SERVICES TO FRIENDS AND/OR FAMILY.
*
STRONGLY AGREE
AGREE
NO OPINION
DISAGREE
STRONGLY DISAGREE
13. WHAT IMPRESSED YOU MOST ABOUT OUR SERVICES?
*
14. WHAT DISAPPOINTED YOU MOST ABOUT OUR SERVICES?
*
15. ADDITIONAL SUGGESTIONS YOU WOULD LIKE TO SHARE
*
16. NAME:
*
17. EMAIL ADDRESS:
*
18. DATE:
*
19. PHONE NUMBER:
*
SUBMIT
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