Home
What can we do for you?
Core Services
Additional Services
Job Opportunities
Activities
Passenger Handbook
Calendar
Gallery
Newsletter
Title VI
Procedure
Procedimiento
Complaint Form
Formulario de queja
Notice to the Public
Advisio AI Pubblico
File a Complaint
Contact us
Our Staff
Consumer Satisfaction Survey Questions
Independent Living Services Program
Please select the name of the caseworker or the person that may have assisted you in obtaining your treatment, device, equipment, modification or services.
*
Carole Cosby
JoAnne Fluke
Amy Garcia
Add another staff that may have assisted you
Please specify by checking the box/boxes below as to which service/services you receive, or have received from Disability in Action.
*
Advocacy
Information & Referral
Housing Info & Assistance
IL Skills Training
Peer Support
Recreational Services
Youth Transition Information
Independent Living Services Program Assistance
Other
Select the correct numeric response to each question
1=Strongly Disagree, 2=Disagree, 3=Neither, 4=Agree, 5=Strongly Agree
You were treated in a friendly, caring and respectful manner by the staff of Disability in Action?
*
1
2
3
4
5
Services were provided in a timely manner?
*
1
2
3
4
5
Disability in Action's staff encouraged you to make decisions so that you can live more independently?
*
1
2
3
4
5
The services met your needs?
*
1
2
3
4
5
Disability in Action's services gave you enough information to help you make informed choices?
*
1
2
3
4
5
Your overall experience with Disability in Action, Inc. was excellent?
*
1
2
3
4
5
If given the opportunity, would you utilize the Disability in Action Independent Living Services Program again?
*
1
2
3
4
5
You were satisfied with the services provided?
*
1
2
3
4
5
Your case worker treated you with respect, concern, compassion and dignity?
*
1
2
3
4
5
Comments
*In order to accommodate you, this survey can be conducted using an alternate method if needed. Example: phone, readable text.
Submit
Close this module
We would love to keep you updated...
Add your information below to stay up to date on all of our classes, events and more!
Name
First and Last Name
Email
Email Address
Subscribe
