Client Satisfaction Survey Form

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Which services are you receiving from Person First New Jersey, LLC:

1. Person First New Jersey, LLC support providers are respectful and professional:

Exceeds expectations

Meets expectations

Needs improvement

Don’t know/NA

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2.Person First New Jersey, LLC support providers are responsive.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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3. Person First New Jersey, LLC support providers return my phone calls and emails promptly.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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4. Person First New Jersey, LLC support providers involve me appropriately.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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5. Person First New Jersey, LLC support providers are competent.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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6. The paperwork that Person First New Jersey, LLC support providers turn in is of high quality and timely.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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7. Person First New Jersey, LLC support providers have enough training and knowledge about the people served.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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8. Person First New Jersey, LLC support providers are committed to the people served.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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9. People receive services that address their goals.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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10. Person First New Jersey, LLC adapts their services as needed to meet peoples' needs and wants.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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11. Person First New Jersey, LLC helps develop high quality service plans for people (and discharge plans, when appropriate)

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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12. Person First New Jersey, LLC takes appropriate actions and follows-up in a crisis or emergency situation.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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13. Person First New Jersey, LLC supports service recipients in exercising their rights.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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14. Person First New Jersey, LLC treats people served with dignity and respect.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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15. Person First New Jersey, LLC has systems and procedures in place that minimize the chance of abuse, neglect, mistreatment and exploitation.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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16. Person First New Jersey, LLC On a scale from 0-10, how likely are you to recommend.

17. Overall I am satisfied with services provided by Person First New Jersey, LLC

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

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18. Are you also a Guardian?

Yes

No

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