Empowering People with Disabilities for a More Fulfilling Life

Access Independence Consumer Satisfaction Survey

We would like to invite you to participate in our Consumer Satisfaction Survey. Your responses are completely anonymous and confidential.

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The services I received helped me to be more independent.

I chose my independent living goals.

I was in charge of making my own decisions while receiving services.

I received appropriate referrals to community resources from staff.

The staff understood my needs.

I would recommend to a friend or family member.

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The questions below are not required, optional only.

What is your age? (optional)

Gender: (optional)

Ethnicity: (optional)

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The information provided to us will help us improve our services. We value your feedback, remarks, and suggestions about our agency. If you would like us to contact you, please leave your name and contact information.

Name:

Phone Number:

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Access Independence Consumer Satisfaction Survey

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