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2025
Quality
Assurance Survey
Please respond with your rating. 5 being extremely satisfied, 1 being extremely dissastified.
How would you rate the following:
Satisfaction with our agency?
1
2
3
4
5
Quality of care your loved one received?
1
2
3
4
5
Safety, respect and dignity of your loved one's care?
1
2
3
4
5
Reliability and consistency of services?
1
2
3
4
5
Communication and responsiveness from our agency?
1
2
3
4
5
Family Advisor's effectiveness?
1
2
3
4
5
Direct Support Professional performance?
1
2
3
4
5
Progress toward ISP goals?
1
2
3
4
5
Positive Impact and independence for you loved one?
1
2
3
4
5
What are we doing well, or what could we improve?
Submit Your Answers
2025
Quality
Assurance Survey
What aspects of our services do you find satisfactory?
Quality of care provided
Professionalism and friendliness of staff
Reliability of care visits
Communication from the agency
Optional: Other aspects of our services you find satisfactory not listed, if any:
What aspects of our services could be improved?
Quality of care provided
Professionalism and friendliness of staff
Reliability of care visits
Communication from the agency
Optional: What aspects of our services could be improved, if any:
How satisfied are you with the below aspects of our agency:
Quality of Support from your family advisor:
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Overall communication from the agency:
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Ease of intake process:
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Communication with ISP Team (SC):
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Ability To Contact Leadership:
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
If you are dissatisfied with any of the above, please elaborate.
If your loved one received behavioral services from our BCBAs, how satisfied are you with your overall experience?
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
If your loved one received care from our nurse, how satisfied are you with your overall experience?
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
If your loved one received support from an outside DSP, how satisfied are you with your overall experience?
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
How satisfied are you with the below aspects of support from an outside DSP:
Professionalism
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Respect for your loved one
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Reliability
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Communication from the outside DSP
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Investment in your loved one's care and growth
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Showing kindness and compassion
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Level of training/relevant skills
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
If you are dissatisfied with any of the above, please elaborate.
How satisfied are you with the below aspects of support from your Family Advisor:
Frequency of routine check-ins
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Providing services tailored to your loved ones
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Prioritizing the care of your loved ones
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Communication and responsiveness
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
Investment in your loves one's care and growth
Very Dissatisfied
Somewhat Dissatisfied
Neutral
Somewhat Satisfied
Very Satisfied
What is one thing we are currently doing well that we should continue?
Can you share an example of a positive or negative experience?
Do you feel that our services have made a positive difference in your lives?
Did your loved one feel safe and respected while receiving our services?
Have you seen progress toward your loved one's ISP goals?
Did our services support independence and community inclusion for your loved one?
What is one specific thing we could improve immediately?
How could we better serve you?
On a scale of 1-5, how satisfied are you with your overall experience with our agency?
1- Very Dissatisfied
2- Somewhat Dissatisfied
3- Neutral
4- Somewhat Satisfied
5 - Very satisfied
Would you recommend our agency to others?
Yes
No
Unsure
Do you have any additional comments or suggestions for improving our services?
Submit Your Answers
