Stakeholder Satisfaction Survey
Consumer's Name:
Your Name:
Relationship to Consumer:
Date: Survey was Completed:
Instructions: Please read each statement and select the number that best reflects your opinion.
1 2 3 4 5 Very Sometimes Somewhat Not No Satisfied Satisfied Dissatisfied Satisfied Opinion
0 1 2 3 4 5 At the consumer's annual staffing/review, my opinion and input are considered and included in the consumer's assessments and service plan. Comments:
0 1 2 3 4 5 The consumer and I are both treated with respect from the staff at SAVE. Comments:
0 1 2 3 4 5 I feel that the consumer is being assisted/supported to achieve his or her personal goals. Comments:
0 1 2 3 4 5 The consumer's needs are being met by SAVE. Comments:
0 1 2 3 4 5 The consumer's life has improved as a result of the services he/she received. Comments:
0 1 2 3 4 5 I am comfortable with the services the consumer receives from SAVE. Comments:
Yes No If you knew someone who needed our services, would you recommend they attend SAVE?
Yes No Overall, I am satisfied with the services the consumers receive from SAVE.
How can SAVE services be improved?
Thank you for your time spent responding to this survey
Please complete the form above and press the SUBMIT button when finished.
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