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* 1. Are you a person receiving services from Empower Simcoe or a Family Member?

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* 2. What program do you receive services from? (select all that apply)

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* 3. How do you rate the services you receive from Empower Simcoe on a scale of 1 - 10? (1-dissatisfied / 10-very satisfied)

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i We adjusted the number you entered based on the slider’s scale.

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* 4. What do you like about the services you receive?

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* 5. If you could change one thing about the services you receive what would it be?

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* 6. Are you satisfied with Communication from Empower Simcoe?

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* 7. Please tell us how we can improve our communication to you.

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* 8. Are you satisfied with the Response Time to your inquiries?

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* 9. Please tell us what you consider a satisfactory response time.

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* 10. How likely is it that you would recommend Empower Simcoe as a Service Agency on a scale of 1 - 10? (1-unlikely / 10-very likely)

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i We adjusted the number you entered based on the slider’s scale.

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* 11. If you agree to be contacted please share your name and email address.

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