Customer Satisfaction Survey
Date of visit
RequiredI was helped...
RequiredI am:
RequiredWhat services were you requesting/are receiving?
Service Requested
Service Received/Currently Receiving
Older adult assistance (Home Care, Adult Day Care, Congregate Centers, Adults with Disabilities)
Adults with disabilities assistance
Assistance with childcare (0-5 years)
Food assistance
Assistance paying utility bills/with benefit applications
Scholarships
Home rehabilitation/weatherization and beautification assistance
Assistance with transportation to CAHSD programs
Employment preparation and training/Workforce development
Youth programming
Veterans’ services support
Tenant/landlord advocacy
Immigration issues support
Domestic violence, crisis support and/or safe space-shelter services
Substance use treatment support
Initiatives for people impacted by gun violence - Peace and Prosperity (Safe in the 305/other)
General Information Request
Other (Please Describe):
Please select the rating you feel best describes your experience today:
RequiredStrongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Service was provided in a timely manner
Required
I was treated in a respectful and friendly manner
Required
Staff were able to answer my questions
Required
I received the services/assistance I requested
Required
The information/service has been helpful to me and my family
Required
Overall, how satisfied were you with your visit today?
RequiredAre there any additional services you need or would like to see in your community?
Is there anything else you would like to tell us about your experience today?
How did you hear about our services?
RequiredPlease enter your US zip code of residence
Required