Client Satisfaction Survey
Please complete this survey to let us know how we are doing. Your responses will not effect provision of service in any way.
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Date  *
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County of Residence *
Which AAA staff member assisted you? (Choose one or more) *
Required
What type of service did you receive from the AAA? *
Required
Did the AAA program meet your needs? *
Were any questions you had left unanswered? *
If yes, please tell us what questions you still have:
Would you recommend our program to a friend? *
Were you satisfied with the assistance you received? *
If no, please tell us what we could do better: 
Have the services provided helped you to regain your independence/improve your quality of life? *
Do you feel the services you were provided were specific to your needs? *
Were staff able to assist you in obtaining the information in a timely manner? *
Was AAA staff courteous, professional, and helpful? *
Would you return to the AAA for assistance in the future? *
Additional comments:
If you would like the AAA staff to follow up regarding your responses to this survey, please add your contact information below: 
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