Case Management Client Satisfaction Survey

We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance. All submissions are confidential and do not affect benefits and services received.

	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree
The program and my participation in it has been fully explained to me	The program and my participation in it has been fully explained to me Strongly Agree	The program and my participation in it has been fully explained to me Agree	The program and my participation in it has been fully explained to me Not Sure	The program and my participation in it has been fully explained to me Disagree	The program and my participation in it has been fully explained to me Strongly Disagree
I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill)	I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Strongly Agree	I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Agree	I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Not Sure	I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Disagree	I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Strongly Disagree
This program has taught me to find services I need	This program has taught me to find services I need Strongly Agree	This program has taught me to find services I need Agree	This program has taught me to find services I need Not Sure	This program has taught me to find services I need Disagree	This program has taught me to find services I need Strongly Disagree
I am better able to provide for myself and my household	I am better able to provide for myself and my household Strongly Agree	I am better able to provide for myself and my household Agree	I am better able to provide for myself and my household Not Sure	I am better able to provide for myself and my household Disagree	I am better able to provide for myself and my household Strongly Disagree
This program has taught me better problem solving skills	This program has taught me better problem solving skills Strongly Agree	This program has taught me better problem solving skills Agree	This program has taught me better problem solving skills Not Sure	This program has taught me better problem solving skills Disagree	This program has taught me better problem solving skills Strongly Disagree
I am better able to budget	I am better able to budget Strongly Agree	I am better able to budget Agree	I am better able to budget Not Sure	I am better able to budget Disagree	I am better able to budget Strongly Disagree
I am able to candidly speak to my Case Manager	I am able to candidly speak to my Case Manager Strongly Agree	I am able to candidly speak to my Case Manager Agree	I am able to candidly speak to my Case Manager Not Sure	I am able to candidly speak to my Case Manager Disagree	I am able to candidly speak to my Case Manager Strongly Disagree
My Case Manager listens to me	My Case Manager listens to me Strongly Agree	My Case Manager listens to me Agree	My Case Manager listens to me Not Sure	My Case Manager listens to me Disagree	My Case Manager listens to me Strongly Disagree
My Case Manager is easy to contact	My Case Manager is easy to contact Strongly Agree	My Case Manager is easy to contact Agree	My Case Manager is easy to contact Not Sure	My Case Manager is easy to contact Disagree	My Case Manager is easy to contact Strongly Disagree
My Case manager helped me find services I needed	My Case manager helped me find services I needed Strongly Agree	My Case manager helped me find services I needed Agree	My Case manager helped me find services I needed Not Sure	My Case manager helped me find services I needed Disagree	My Case manager helped me find services I needed Strongly Disagree

Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

The program and my participation in it has been fully explained to me

The program and my participation in it has been fully explained to me Strongly Agree

The program and my participation in it has been fully explained to me Agree

The program and my participation in it has been fully explained to me Not Sure

The program and my participation in it has been fully explained to me Disagree

The program and my participation in it has been fully explained to me Strongly Disagree

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill)

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Strongly Agree

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Agree

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Not Sure

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Disagree

I understand that I must participate fully in this program (be on time, complete assignments, update documentation, submit current bill) Strongly Disagree

This program has taught me to find services I need

This program has taught me to find services I need Strongly Agree

This program has taught me to find services I need Agree

This program has taught me to find services I need Not Sure

This program has taught me to find services I need Disagree

This program has taught me to find services I need Strongly Disagree

I am better able to provide for myself and my household

I am better able to provide for myself and my household Strongly Agree

I am better able to provide for myself and my household Agree

I am better able to provide for myself and my household Not Sure

I am better able to provide for myself and my household Disagree

I am better able to provide for myself and my household Strongly Disagree

This program has taught me better problem solving skills

This program has taught me better problem solving skills Strongly Agree

This program has taught me better problem solving skills Agree

This program has taught me better problem solving skills Not Sure

This program has taught me better problem solving skills Disagree

This program has taught me better problem solving skills Strongly Disagree

I am better able to budget

I am better able to budget Strongly Agree

I am better able to budget Agree

I am better able to budget Not Sure

I am better able to budget Disagree

I am better able to budget Strongly Disagree

I am able to candidly speak to my Case Manager

I am able to candidly speak to my Case Manager Strongly Agree

I am able to candidly speak to my Case Manager Agree

I am able to candidly speak to my Case Manager Not Sure

I am able to candidly speak to my Case Manager Disagree

I am able to candidly speak to my Case Manager Strongly Disagree

My Case Manager listens to me

My Case Manager listens to me Strongly Agree

My Case Manager listens to me Agree

My Case Manager listens to me Not Sure

My Case Manager listens to me Disagree

My Case Manager listens to me Strongly Disagree

My Case Manager is easy to contact

My Case Manager is easy to contact Strongly Agree

My Case Manager is easy to contact Agree

My Case Manager is easy to contact Not Sure

My Case Manager is easy to contact Disagree

My Case Manager is easy to contact Strongly Disagree

My Case manager helped me find services I needed

My Case manager helped me find services I needed Strongly Agree

My Case manager helped me find services I needed Agree

My Case manager helped me find services I needed Not Sure

My Case manager helped me find services I needed Disagree

My Case manager helped me find services I needed Strongly Disagree

Case Management Client Satisfaction Survey

How Are We Doing?

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* 1. What was the name of your Case Manager?

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* 2. Check your response:

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* 3. If you answered Disagree or Strongly Disagree to the questions above, please explain why:

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* 4. Would you be interested in sharing your story with us?

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* 5. If yes, please share below and fill out the contact information following

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* 6. Contact Information