1.Please select the case manager you recently worked with

Tori

Tamara

Tammy

2.Case management has helped me with the following (select all that apply)

Medicine

Food

Housing

Transportation

Sliding Scale

Insurance

Behavioral Health referrals

Other

3.Staff were professional and knowledgeable

Exceptional

Good

Fair

Poor

N/A

4.Staff followed through as needed in a timely manner

Exceptional

Good

Fair

Poor

N/A

5.Communications are clear and concise

Exceptional

Good

Fair

Poor

N/A

6.Fully attentive to your needs and requests

Exceptional

Good

Fair

Poor

N/A

7.Complaints and/or concerns have been addressed in a timely manner

Exceptional

Good

Fair

Poor

N/A

8.Other comments and/or suggestions:

9.Please leave your name and number if you would like to speak to someone regarding your recent visit with case management.