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CIL Satisfaction Survey

Which staff member assisted you last?

What is your annual household income?

All of my expectations were met (please select the answer that best fits)

The person who assisted me was courteous (please select the answer that best fits)

The person who assisted me was knowledgeable (please select the answer that best fits)

I am better able to take care of myself (please select the answer that best fits)

I am better able to access my home and/or community (please select the answer that best fits)

My overall quality of life has improved (please select the answer that best fits)

I am completely satisfied with how I was served (please select the answer that best fits)

I would refer others to the CIL (please select the answer that best fits)

Do you have any additional comments? Please share them with us.

Would you like to include your personal/ contact information? This information will remain confidential.

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