Copy of Placer ADRC Consumer Experience Survey 23-24

Please Complete this by July 12th, 2024

The Placer Aging and Disability Resource Connection (ADRC) is a partnership between the local Agency on Aging Area 4 (AAA4), Placer Independent Resource Services (PIRS), and local agencies providing services to people with disabilities and older adults. The ADRC focuses on providing the following core services:

1.     Enhanced Information, and Assistance
2.     Person Centered Options Counseling
3.     Short Term Service Coordination
4.     Person Centered Transition Support

Your local ADRC would like to learn about your experience with the  services and program between July 1st, 2023 and June 30th, 2024. Please complete one survey for each person who received services. If you are a caregiver, please answer the questions on how the ADRC supported your interests and needs as a caregiver.

This survey should take less than five minutes and will help us learn how helpful we are to you and what we could do better to meet your need(s).

Please share your experience. It is greatly appreciated. Thank you!
1.Are you a:
2.My interests and needs were discussed.
3.I was treated with courtesy and dignity.
4.I have more information and choices because of the services/assistance I received.
5.I am more confident that I will be able to manage my life better because of the services/assistance I received.
6.The services/assistance I received improved my health, safety, and/or well-being.
7.What, if anything, could we have done better?
8.What kind of help or services were you looking for?
9.Based on your experience, what did you find helpful? Please select those that may apply. [*Optional Question]
10.May we contact you to discuss your experience?
11.If you answered "Yes" to number 10, please provide your phone number below.
12.Which organization/agency did you work with? 
Current Progress,
0 of 12 answered