Agency Stakeholder Annual Satisfaction Survey Question Title * 1. Date Date Date Question Title * 2. How likely is it that you would recommend Empowering Minds to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 3. Which of the following words would you use to describe our services? Select all that apply. Reliable High quality Useful Unique Impractical Ineffective Poor quality Unreliable Question Title * 4. How well does our services meet your needs? Extremely well Very well Somewhat well Not so well Not at all well Question Title * 5. How would you rate the quality of the services you agency receives? Very high quality High quality Neither high nor low quality Low quality Very low quality Question Title * 6. How responsive have we been to your questions or concerns about the clients you refer? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive Not applicable Question Title * 7. How likely are you to refer your clients to Empowering Minds PRP? Very Likely Likely Not Likely Neutral Question Title * 8. How long have you been a Partner/Stakeholder/Referral Source of Empowering Minds? Less than six months 1-2 years 3 or more years I am not a Partner/Stakeholder/Referral Source Other (please specify) Question Title * 9. Overall, how satisfied or dissatisfied are you with agency? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 10. Do you have any other comments, questions, or concerns? Done