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Consumer Satisfaction Survey

1. Are you a: (Click all that Apply)
2. Did Rolling Start return your telephone call(s) in a timely manner? (within 3 days)
Please rate the following items according to your level of agreement on a scale of 1-5, with 1 being you strongly disagree and 5 being you strongly agree. If the item does not apply to you, please leave it blank.
5. The reception staff was friendly, helpful, and respectful.
6. My interests and needs were discussed.
7. The person who assisted me was knowledgeable.
8. I was treated with courtesy and dignity.
9. I have more information and choices because of the services/assistance I received.
10. I am more Independent and can manage my life better because of the services/assistance.
11. The services/assistance I received improved my health, safety, and/or well-being.
12. I would refer others to Rolling Start.
13. Based on your experience, what did you find helpful? Please select all that apply.
15. (Optional) May we contact you regarding your experience?
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