Consumer Satisfaction Survey

Please take a moment to fill out the following survey which will allow us to gauge how we are doing and what we can be doing differently or better.

  1. Please identify and describe yourself:

    Age
    Sex Male Female

  2. Please select three changes you would like see in your life:

    A different place to live
    More Support at home
    more financial support
    employment
    transportation to social events
    more access to counseling services
    more peer support services
    access to health care

  3. What is the most important area in which you would like to see DNEC advocate with state and federal policymakers:

    access to Affordable housing
    More support at home
    more Financial Support
    Employment Services
    Availability of accessible transportation
    Access to Counseling services
    more peer support
    access to better health care

  4. The second most important?

    access to Affordable housing
    More support at home
    more Financial Support
    Employment Services
    Availability of accessible transportation
    Access to Counseling services
    more peer support
    access to better health care

  5. Your third choice?

    access to Affordable housing
    More support at home
    more Financial Support
    Employment Services
    Availability of accessible transportation
    Access to Counseling services
    more peer support
    access to better health care

  6. Other


  7. Are you satisfied with the services DNEC has provided you?

    yes
    no
    sometimes
    not sure

  8. How can we improve and better help you? Do you have questions or complaints you'd like to share?


  9. What types of services and activities would you like DNEC to increase or add in the future?


  10. Would you like to learn more about DNEC?

    Yes No

  11. Would you like to receive our newsletter? Please also click here to provide your contact information.

    Yes No

  12. Would you be interested in joining the DNEC Community in any of the following efforts?

    Changing the system (calling, writing, or visiting your legislators)
    Participating in a support group
    Recreational Activities
    Computer or American Sign Language or Independent Living Skills Classes
    Caregiver's or women's support group

  13. Are you safe?

    Yes No

  14. If not, how can we help?


  15. What town do you live in?


  16. Are you a...:

    Consumer
    Family Member
    Service Provider
    Community Agency
    Interested Citizen

  17. Do you have a disability?

    Yes No

  18. if yes, would you please tell us what it is?


  19. How did you find out about DNEC?


  20. Would you contact us again?

    Yes No

  21. Would you recommend us to others?

    Yes No

  22. What else should we have asked, or are there other comments you would like to share?



Copyright © 2008 [DNEC]. All rights reserved.
Revised: 02/28/08