Header - Survey Questions
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Header Section - #95B3D7 |
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? |
Header - Optional Questions
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Header Section - #95B3D7 |
Name of Respondent (Optional)
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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)
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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? |