Hearth Residential / Adult Life Programs Satisfaction Survey





Your Position
Case ManagerQMRPParent/GuardianOther (Specify Below)

Other Position Detail

Name / Agency

Identify Hearth Residential / Adult Life Programs staff with whom you have worked:

How long have you had a client(s) receiving services at Hearth Residential / Adult Life Programs?

0-6 months6-12 months12-24 months24+ months

Hearth Residential / Adult Life Programs environment is safe and conducive to personal development of the client.

Disagree StronglyDisagreeNeither Agree or DisagreeAgreeAgree StronglyN/A

Comments:

You feel staff are caring and concerned and offer the proper support to the consumer.

Disagree StronglyDisagreeNeither Agree or DisagreeAgreeAgree StronglyN/A

Comments:

Communication to you is adequate.

Disagree StronglyDisagreeNeither Agree or DisagreeAgreeAgree StronglyN/A

Comments:

Program monitoring is done on a regular basis and feedback is provided.

Disagree StronglyDisagreeNeither Agree or DisagreeAgreeAgree StronglyN/A

Comments:

The client treated with dignity and respect.

Disagree StronglyDisagreeNeither Agree or DisagreeAgreeAgree StronglyN/A

Comments:

What can Hearth Residential / Adult Life Programs do to better meet your needs?

Would you like us to contact you? If so, please provide us with your name, and then either an e-mail address or phone number.

Your Name (optional)

Your Phone or E-mail (optional)

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