EmailMe Form - Satisfaction Survey

Consumer's Name *

Behavior Consultant/Communication Specialist/Supervisor *

Behavior Consultant Supervisor *

1. The Behavior Consultant (BC)/Communication Specialist (CS) arrives on time for scheduled appointments *

2. The Behavior Consultant/Communication Specialist is respectful and interacts appropriately wtih consumers *

3. The Behavior Consultant/Communication Specialist accepts and encourages input from all team members *

4. The Behavior Consultant/Communication Specialist attends scheduled team meetings *

5. The Behavior Consultant/Communication Specialist notifies team members when needing to cancel visits/appointments in a timely manner *

6. Behavior Support Plans/Action Plans and other reports are easy to understand *

7. The Behavior Consultant provides data (and analysis of data) to team members on a regular basis (not applicable to Communication Specialist cases) *

8. The consumer is benefitting from services provided *

9. The Behavior Consultant/Communication Specialist is professional in appearance and interaction *

10. The team has the opportunity to contact a Supervisor or Executive Director at The Cornerstone Agency if needed at any time *

11. The Cornerstone Agency provides quality services to individuals with disabilities *

12. I would recommend The Cornerstone Agency to others *

Comments:

Person Completing Survey *

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