New Hope Services, Inc.
(812) 288-8248

ASClientSurvey

Adult Services Client Satisfaction Survey

  • Date Format: MM slash DD slash YYYY
    Date
  • Client Name
  • Name of Individual Completing this Survey:
  • Which of the following services have you used with New Hope Services in the last 12 months?
  • For each area below, please select a response indicating how satisfied or dissatisfied you are with New Hope Services. (top description)
    Very DissatisfiedSomewhat DissatisfiedNeutral/No OpinionSatisfiedVery Satisfied
    Responsiveness to your Needs
    Treatment from Staff
    Effectiveness of Services
    Overall Quality of Services
  • Overall, has New Hope Services increased your Community Integration?
  • Overall, has New Hope Services helped you become more independent?
  • Overall, has New Hope Services enhanced your Quality of Life?
  • On a scale of 1 - 10, how likely are you to refer someone to New Hope Services?
    1 - Not Likely at All2345 - Somewhat Likely678910 - Extremely Likely
  • Please leave us feedback to better explain your responses above and to let us know how we're doing.