Adult Services Community Friends Survey Adult Services Community Friends Survey DateDate: MM slash DD slash YYYY Name*Name: Relationship with New Hope*What is your relationship with New Hope Services, Inc.? Family/Guardian/Caretaker Case Manager School Partner Medical Professional Vocational Rehabilitation Behavior Clinician State Employee Would Rather Not Say Other Provider Community Partner Employment Partner Other (Can elaborate below) Other RelationshipOther Relationship Satisfaction*Please select a response indicating how satisfied or dissatisfied you are with New Hope Services:Very DissatisfiedSomewhat DissatisfiedNeutral/No OpinionSatisfiedVery SatisfiedResponse Time and CommunicationKnowledgeable Staff and ManagementLevel of Respect and ProfessionalismOverall Quality of Client ServicesReferral Likelihood*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 LikelyImproves Lives*Overall, do you feel that New Hope Services improves the lives of adults with disabilities? YES NO N/A or Don't Know Increases community integration*Overall, do you feel that New Hope Services increases community integration for adults with disabilities? YES NO N/A or Don't Know Provides important community services*Overall, do you feel that New Hope Services provides important and necessary services to the community? YES NO N/A or Don't Know FeedbackPlease leave us feedback to better explain your responses above:Improvements we could makePlease let us know if there are any processes, services, or improvements that you feel we could implement to enhance our current quality of care:CAPTCHA Δ