* = Required Information
Date
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Agency/Organization
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1. How would you rate a quality of introduction to our services you had received before you started using our services (consider e.g., completeness and accuracy of informational session)
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1-Low
2
3
4-High
Please explain what we can do to improve in this area
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2. How would you rate quality of our services (consider e.g., good relationship with clients, addressing appropriate problems with clients, linking them other resources) *
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1-Low
2
3
4-High
Please explain what we can do to improve our performance in this area
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3. How would you rate the professional behavior of our Direct Care staff (e.g., staff integrity, competency, returning phone calls within 24 hours, proper dress code, using the proper language)?
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1-Low
2
3
4-High
Please explain. What we can do to improve our performance in this criterion?
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4. How would you rate skills/knowledge/expertise of our administrative staff?
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1-Low
2
3
4-High
Please explain. What we can do to improve our performance in this criterion?
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5. How would you rate the quality and timeliness of our paperwork (please consider completeness, accuracy, relevancy, on-time submission, reporting period)
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1-Low
2
3
4-High
Please explain. What we can do to improve our performance in this criterion?
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6. Are there any additional services that you would like to see us providing? If yes, which ones?
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