Copy of Copy of Customer Satisfaction Survey VITAL Services, Inc. is conducting a survey to improve the quality of our services. Question Title * 1. How long have you been affiliated with VITAL Services Inc.? Less than six months Six months to a year 1 - 2 years More than 2 years I am not a customer Question Title * 2. How satisfied are you with your line of communication with VITAL Services, Inc? Extremely satisfied Very satisfied Somewhat satisfied Not so satisfied Not satisfied at all Other (please specify) Question Title * 3. Do you know whom to contact when an issue or question arises? Yes No Other (please specify) Question Title * 4. Do you feel that your concerns are responded to in a timely fashion? Yes No Other (please specify) Question Title * 5. Do you feel that VITAL staff, managers, coordinators, and directors are friendly and respectful to you and/ or the participant in services? Yes No Other (please specify) Question Title * 6. Do you feel that staff, managers, coordinators, and directors are "team players" in the ISP process, willing to cooperate and meet team expectations and requests? Yes No Other (please specify) Question Title * 7. Do you feel that VITAL Services, Inc is meeting your needs or the needs of the participant receiving services? Yes No Other (please specify) Question Title * 8. Do you feel the physical environment where you live or work or where the participant lives or works is kept in good condition, is clean and is safe? Yes No Other (please specify) Question Title * 9. Do you feel that VITAL services, Inc. is providing you an opportunity for choice or giving the participant an opportunity to have a choice in how her/his daily life in constructed? Yes No Other (please specify) Done