INW Customer and Community Partner Feedback

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* 1. Which of these best describes your relationship to Independence Northwest?

I am an INW customer

I am the family member of an INW customer

I am a provider for an INW customer

I am a community partner

Other (please specify)

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* 2. On a scale of 1 to 5, how would you rate your experience with us at Independence Northwest?

5 - Very Satisfied

4 - Satisfied

3 - They're Okay

2 - Somewhat Dissatisfied

1 - Very Dissatisfied

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* 3. What feedback would you like to share with us about your experience working with us?

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* 4. Is there anything we can do to better serve you, your family, someone you know, or the disability community?

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* 5. Would you like us to contact you to follow up on anything you've shared today?

Yes, please email me.

Yes, please call me.

No thanks. No follow up necessary.

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* 6. What's your name (if you're comfortable sharing)?

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* 7. If you would like us to follow up with you, please enter your email or phone number below and someone from our office will be in touch with you within five working days.