Access Technology Client Satisfaction Survey

Your personal comments are important to assure the continued success of this program. Please take a few moments to complete these questions.

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Personal Information:
Name :
E-mail *:
Service/Program Information:
Type of service provided to you (check all that apply):	Evaluation Worksite Assessment Device Training Computer Training Equipment Installation Other (If other please specify)
Service/Program Ratings:
The service you received was (check one for each area):   Courteous Clearly explained Centered on your needs Excellent Very Good Average Fair Poor N/A Rate the following areas (Check one for each area):   Timeliness of appointment Expertise of evaluator Professionalism Range of devices adequate for your needs? Excellent Very Good Average Fair Poor N/A
What, if any, areas do you feel could be improved or strengthened?
Additional comments:
( * denotes required fields)