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To thank you for taking the time to give us your feedback, all consumers can enter into a drawing for a gift card. If interested, please give us your name and phone. Drawing will be at the end of September.
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1. Are you a:
2. Which county do you reside in?
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3. The primary support received from Access North was (i.e. Personal Care Assistant, Home Mod, Independent Living, etc.)
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4. Which staff did you work with? If more than one, please be specific.
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5. Was the staff polite, respectful and timely?
Please tell us of your experience
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Answer all of the following questions based on the services received from Access North
6. Was the person receiving services involved in the planning, direction and activities of the services received:
7. Was the person receiving services given thorough and accurate information about the programs and services received?
Comment
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8. The person receiving services had increased access to affordable and adequate …
9. The person receiving services experienced an increase in independence and personal growth.
10. On a scale of 1 to 5, how satisfied are you with the services received from Access North?
Very Unsatisfied
Very Satisfied
11. What groups or classes would you like to see us offer and in which communities do you see this need?
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Only answer the following questions if you received a ramp or home modification from Access North

12. Was the project completed to your satisfaction?
Comment
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13. Did the quality of the work meet your expectations?
Comment
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14. IF YOU HAVE ANY FURTHER COMMENTS … Please provide them here so that we can improve our services:
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