Satisfaction Survey

Please complete the following Satisfaction Survey based on services we provide to you/your loved one. Thank you for your time.

* Full Name
Relationship to Individual

* Email

* Your rights have been explained to you in a way that you are able to understand

* When discussing your needs and goals, your input is used to create your plan

* Your questions are answered thoroughly and in a timely manner.

* CCMS is an effective advocate for you (helps you tell other people what you need).

* CCMS keeps my private information private.

* There are an adequate amount (enough) of CCMS personnel to address my needs.

* I'm contacted, at least monthly, from CCMS to inquire about my needs.

* CCMS personnel respect my culture.

* Overall satisfaction with your service experience.

How Can We Better Serve you?

Additional Comments/Testimonial