Header - Survey Questions
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Header Section - #95B3D7 |
Q1a *
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On a scale of 1 to 10, how likely is it that you would recommend this service to a friend? With 10 being the highest and 1 being the lowest |
Q1b *
| Do you like going to Respite? |
Q2 *
| Do you like your Respite Caregiver? |
Q3 *
| When you go to respite, do you get to participate in activities? |
Q4 *
| Do you get to decide what to do during your respite visit (ie: food you eat, things you do)? |
Q5 *
| Do you know who the Respite Manager is? |
Is an immediate follow-up required by CSCL?
| Would you like someone from CSCL's Leadership team to follow up with you regarding any concerns? |
Header - Optional Questions:
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Header Section - #95B3D7 |
Header - Post Survey/Administration Section:
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Header Section - #95B3D7 |
Staff/Caregiver (If Assisted)
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Service
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Survey Time
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How long did it take to complete this survey (in minutes)? |
Follow Up Required?
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Is an immediate follow-up required by CSCL? |
Header - Management Section:
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Header Section - #95B3D7 |