EmailMeForm
Satisfaction Survey
It is our desire to provide high quality services to individuals with disabilities. Your feedback is essential and allows us to improve our program. We appreciate your time in completing this survey.
Consumer's Name
*
Behavior Consultant/Communication Specialist/Supervisor
*
Please select
Amy Mills
Brenda Laubach
Jamie Myers
Jennifer Lengle
Jordan Korge
Kate Hall Robbins
Lance Wallace
Laura Myers
Madison Stansfield
Michelle Linnen
Michelle Stagmer
Nancy Nash
Rosa Soto
Sam Stein
Samantha Baker
Sara Bangura
Sean Jarman
Sunny Dixon
Behavior Consultant Supervisor
*
Please select
Brenda Laubach
Jennifer Lengle
Michelle Stagmer
Nicole Deibler
Tricia Eganey-Rollins
1. The Behavior Consultant (BC)/Communication Specialist (CS) arrives on time for scheduled appointments
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
2. The Behavior Consultant/Communication Specialist is respectful and interacts appropriately wtih consumers
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
3. The Behavior Consultant/Communication Specialist accepts and encourages input from all team members
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
4. The Behavior Consultant/Communication Specialist attends scheduled team meetings
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
5. The Behavior Consultant/Communication Specialist notifies team members when needing to cancel visits/appointments in a timely manner
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
6. Behavior Support Plans/Action Plans and other reports are easy to understand
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
7. The Behavior Consultant provides data (and analysis of data) to team members on a regular basis (not applicable to Communication Specialist cases)
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
8. The consumer is benefitting from services provided
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
9. The Behavior Consultant/Communication Specialist is professional in appearance and interaction
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
10. The team has the opportunity to contact a Supervisor or Executive Director at The Cornerstone Agency if needed at any time
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
11. The Cornerstone Agency provides quality services to individuals with disabilities
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
12. I would recommend The Cornerstone Agency to others
*
Please select
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
Comments:
Person Completing Survey
*
First
Last
Title
Phone
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