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COMMENT MODE

Lincoln Trail Customer Satisfaction Survey

Please help us improve by taking this short survey. Thank you!

1. Type of service

Date of virtual communication This question requires a valid date format of MM/DD/YYYY.

calendar

Date of in-person visit This question requires a valid date format of MM/DD/YYYY.

calendar

How long did you have to wait once you arrived?

How long did you have to wait once you called?

2. How much do you agree with the following statements?

Space Cell	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree
Appointment times worked with my schedule.	Appointment times worked with my schedule.: Strongly Agree	Appointment times worked with my schedule.: Agree	Appointment times worked with my schedule.: Neither Agree or Disagree	Appointment times worked with my schedule.: Disagree	Appointment times worked with my schedule.: Strongly Disagree
The service I needed was available at the facility.	The service I needed was available at the facility.: Strongly Agree	The service I needed was available at the facility.: Agree	The service I needed was available at the facility.: Neither Agree or Disagree	The service I needed was available at the facility.: Disagree	The service I needed was available at the facility.: Strongly Disagree
The staff was helpful.	The staff was helpful.: Strongly Agree	The staff was helpful.: Agree	The staff was helpful.: Neither Agree or Disagree	The staff was helpful.: Disagree	The staff was helpful.: Strongly Disagree
I received the information I needed.	I received the information I needed.: Strongly Agree	I received the information I needed.: Agree	I received the information I needed.: Neither Agree or Disagree	I received the information I needed.: Disagree	I received the information I needed.: Strongly Disagree
Information provided by receptionist was clear/understandable.	Information provided by receptionist was clear/understandable.: Strongly Agree	Information provided by receptionist was clear/understandable.: Agree	Information provided by receptionist was clear/understandable.: Neither Agree or Disagree	Information provided by receptionist was clear/understandable.: Disagree	Information provided by receptionist was clear/understandable.: Strongly Disagree
Information provided by provider was clear/understandable.	Information provided by provider was clear/understandable.: Strongly Agree	Information provided by provider was clear/understandable.: Agree	Information provided by provider was clear/understandable.: Neither Agree or Disagree	Information provided by provider was clear/understandable.: Disagree	Information provided by provider was clear/understandable.: Strongly Disagree
Staff was well informed.	Staff was well informed.: Strongly Agree	Staff was well informed.: Agree	Staff was well informed.: Neither Agree or Disagree	Staff was well informed.: Disagree	Staff was well informed.: Strongly Disagree
I was served in a timely manner.	I was served in a timely manner.: Strongly Agree	I was served in a timely manner.: Agree	I was served in a timely manner.: Neither Agree or Disagree	I was served in a timely manner.: Disagree	I was served in a timely manner.: Strongly Disagree
The facility was clean.	The facility was clean.: Strongly Agree	The facility was clean.: Agree	The facility was clean.: Neither Agree or Disagree	The facility was clean.: Disagree	The facility was clean.: Strongly Disagree
My privacy was respected.	My privacy was respected.: Strongly Agree	My privacy was respected.: Agree	My privacy was respected.: Neither Agree or Disagree	My privacy was respected.: Disagree	My privacy was respected.: Strongly Disagree
Staff respected my cultural beliefs.	Staff respected my cultural beliefs.: Strongly Agree	Staff respected my cultural beliefs.: Agree	Staff respected my cultural beliefs.: Neither Agree or Disagree	Staff respected my cultural beliefs.: Disagree	Staff respected my cultural beliefs.: Strongly Disagree
Enter another option	Other: Strongly Agree	Other: Agree	Other: Neither Agree or Disagree	Other: Disagree	Other: Strongly Disagree

You answered strongly disagree or disagree to at least one of these questions, please explain why.

3. How satisfied were you with your overall experience?

Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied

What was your reason for contacting us? check all that apply

What was your reason for visiting us? check all that apply

4. What did we do well?

5. What could we do better?

6. How did you hear about our services?

Please enter an 'other' value for this selection.

7. Would you like to be contacted by a staff member to discuss your responses?

If yes, please list your name and contact information.

Name
Phone Number
Email