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New Survey: Survey - SSH Family


 
Header - Survey Questions
Header Section - #95B3D7
Date of Survey
Select a date from the calendar.
Year
Q1 *
Describe your level of satisfaction with your family member's Staff Supported Home Service.
Q2 *
Is your family member treated respectfully?
Q3 *
Are you confident that your family member’s personal information is kept confidential?
Q4 *
Is your family member safe living in a CSCL Staff Supported Home?
Comments
Please provide any additional comments here.
Header - Optional Questions
Header Section - #95B3D7
Name of Respondent (Optional)
If you wish to have your name entered in the draw to win a $50 Gift Card to Cottonwood Mall (to be drawn in December) please include your name!
Individual (Optional)
What is the name of your family member?
Relationship (Optional)
   
What is your relationship of the person receiving CSCL Staff Supported Home Services?
Living Situation (Optional)
Where does your family member live?
Follow Up?
Is an immediate follow-up required by CSCL?
View *