Satisfaction What was the Date of your Agency Contact? What type of Contact? Office Phone What brought you to our Office? New Application Re-Application Job Search Which Department did you see? Medicaid, Food-Stamps, Cash Assistance One Stop Job and Training Services Child Care Child Support Children Services Did you have a Scheduled Appointment? Yes No How long did you wait? Less than 5 Minuets 5 to 15 minuets More than 15 minuets Was there any services you expected and did not receive? Yes (Please explain below) No Explaination Were you treated courteously? Yes No (Please explain below) Explaination Did the Agency assist you in finding services elsewhere if we could not help? Yes No (Please explain below) Explaination Were your questions answered? Yes No (Please explain below) Explaination Were your telephone calls returned? Yes No (Please explain below) Explaination In general, how do you feel about the services provided by this Agency? Very Satisfied Somewhat Satisfied Neither Satisfied nor Dissatisfied Somewhat Dissatisfied Very Dissatisfied If you would like us to contact you to help with any questions or concerns please leave your full name, phone number, where we can reach you and a complete explaination of your question so we can get you to the correct person. Any comments you may have can also be placed below. Posted in .