Free 47204.pdf - Indiana

SF 47204 (6-98) / VRS 0015

HOW ARE WE DOING?

SF 47204 (6-98) / VRS 0015

HOW ARE WE DOING?

DIRECTIONS: Please circle the answer to the right which BEST tells how you feel about the question. 1. Do VR employees treat you with respect? 2. Are your concerns being listened to and dealt with? 3. Does your counselor keep in close enough contact with you? 4. Are you receiving services fast enough? VERY MUCH VERY MUCH VERY MUCH VERY MUCH SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT A LITTLE A LITTLE A LITTLE A LITTLE A LITTLE NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL

DIRECTIONS: Please circle the answer to the right which BEST tells how you feel about the question. 1. Do VR employees treat you with respect? 2. Are your concerns being listened to and dealt with? 3. Does your counselor keep in close enough contact with you? 4. Are you receiving services fast enough? VERY MUCH VERY MUCH VERY MUCH VERY MUCH SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT A LITTLE A LITTLE A LITTLE A LITTLE A LITTLE NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL

5. Are you satisfied with the help you are receiving? VERY MUCH
Comments:

5. Are you satisfied with the help you are receiving? VERY MUCH
Comments:

Name (optional)

Telephone number

Name (optional)

Telephone number

I would like a call from the Supervisor

Yes

No

I would like a call from the Supervisor

Yes

No

SF 47204 (6-98) / VRS 0015

HOW ARE WE DOING?

SF 47204 (6-98) / VRS 0015

HOW ARE WE DOING?

DIRECTIONS: Please circle the answer to the right which BEST tells how you feel about the question. 1. Do VR employees treat you with respect? 2. Are your concerns being listened to and dealt with? 3. Does your counselor keep in close enough contact with you? 4. Are you receiving services fast enough? VERY MUCH VERY MUCH VERY MUCH VERY MUCH SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT A LITTLE A LITTLE A LITTLE A LITTLE A LITTLE NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL

DIRECTIONS: Please circle the answer to the right which BEST tells how you feel about the question. 1. Do VR employees treat you with respect? 2. Are your concerns being listened to and dealt with? 3. Does your counselor keep in close enough contact with you? 4. Are you receiving services fast enough? VERY MUCH VERY MUCH VERY MUCH VERY MUCH SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT SOMEWHAT A LITTLE A LITTLE A LITTLE A LITTLE A LITTLE NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL NOT AT ALL

5. Are you satisfied with the help you are receiving? VERY MUCH
Comments:

5. Are you satisfied with the help you are receiving? VERY MUCH
Comments:

Name (optional)

Telephone number

Name (optional)

Telephone number

I would like a call from the Supervisor

Yes

No

I would like a call from the Supervisor

Yes

No