INW Customer Satisfaction and Feedback Survey
*
1.
Please enter the four-digit code you received. (Check the mailer we sent you for a purple sheet - it's printed in bold in the center of the page.)
(Required.)
2.
Who is completing this survey?
INW customer
INW customer with help from a trusted family member
INW customer with help from a trusted friend
INW customer with help from a trusted provider
*
3.
Who is your Personal Agent at Independence Northwest?
(Required.)
Adrienne Akin
Andrea Ochsner
Angie Frank
Bernice Celino
Carl Fischer
Chris Psota
Clover Mow
Emily Dinwiddie
Jamie Osborn (formerly Jamie Lyzell)
Jenna Holt
Jesse Raposa
Jessica Kral
Joe Connell
Rondi Grace
I'm Not Sure
4.
Do you get the supports you need from INW?
Yes
Sometimes
No
Don't Know
Prefer Not to Answer
Comments:
5.
How often do you communicate with your Personal Agent?
More than once a week
About once a week
A couple times a month
Monthly
Quarterly
Other (please specify)
6.
Due to the pandemic, we can't meet face to face. During this time, what's your preferred way of connecting with your Personal Agent?
On video chat (such as Zoom, Google Hangouts, Messenger, etc.)
On the phone
Through email
Through texting
Comments:
7.
Are you happy with how often your Personal Agent connects with you?
Yes
No - I'd like to communicate MORE often
No - I'd like to communicate LESS often
Comments:
8.
When you need help making decisions, does your INW Personal Agent help you?
Yes
Sometimes
No
Don't Know
Prefer Not to Answer
Comments:
9.
One of the primary aims of Independence Northwest is to help you get connected to the supports you need. Are there unmet needs you have right now that you'd like our help with?
10.
Would you like our assistance in accessing Personal Protective Equipment like masks and gloves?
No thanks, I'm good.
Yes, I would like assistance with getting masks
Yes, I would like assistance with getting gloves
Yes, I would like assistance getting masks AND gloves
11.
Would you like our support in getting you connected with COVID-19 vaccine clinics?
Yes. I'd like INW to help me find a clinic and get signed up.
No thanks. I have already taken the vaccine.
No thanks. I already have an appointment.
No thanks. I have decided not to take the vaccine.
I prefer not to answer.
Comments:
12.
How would you rate your happiness with your services from Independence Northwest
5 - Very Satisfied
4 - Satisfied
3 - They're Okay
2 - Somewhat Dissatisfied
1 - Very Dissatisfied
13.
Do you have any other feedback you'd like to share with us about your experience as an INW customer?
14.
If you would like your PA or a member of our team to follow up with you on outstanding questions or concerns, please include your name and best way to contact you (phone or email) and we will be sure to be in touch soon.
Current Progress,
0 of 14 answered
