Consumer Satisfaction Survey

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Your feedback is important to us to see if we are meeting your needs. Thank you for taking the time to fill out this survey. The survey is confidential.

In the past year, what kind of help did you get from NILP? Check the box next to help you received this year. *

Learning about my options for personal care and in-home support

Supports for leaving a nursing home or hospital

Looking for affordable and accessible housing

Learning about getting equipment or devices for communication, mobility or vision

Getting help with language or communication needs

Planning my transition out high school

Finding out about accessible transportation services

Obtaining all the benefits that I am eligible for (such as MassHealth, food stamps, fuel assistance).

Help me find education or employment services

Understanding my civil rights (such as the ADA, Fair Housing law or other laws)

Help understanding my disability and advocating for myself.

Increasing my access to health care

Finding and keeping Personal Care Attendant (PCA) services

Required

Did NILP help you with something not listed above? Please describe:

Do you have an Independent Living Plan? *

Yes

I don't know

If you have an Independent Living Plan , what was most important in developing your plan? Check only one.

I chose my Independent Living Plan goals.

My NILP staff person and I developed my Independent Living Plan goals together.

My NILP staff person developed my Independent Living Plan for me.

Clear selection

Please select the option that shows how much you disagree, somewhat agree, or strongly agree with each one. *

Disagree

Somewhat agree

Strongly agree

Don't know

I received assistance immediately

My phone calls are returned promptly by NILP

NILP treats me with respect

I would recommend NILP to a friend or family member

I am happy with the quality of services I receive from NILP

How has NILP helped you?

What else could NILP do to help you live independently?

What language do you speak at home? (Optional)

How well do you speak English? (Optional)

Very well

Well

Not well

Not at all

Clear selection

How old are you? (Optional)

13 or younger

14-22

23-29

30-39

40-49

50-59

60 or older

Clear selection

Are you Hispanic or Latino? (Optional)

Yes

Clear selection

What is your race? Check all that apply. (Optional)

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Other:

What is your gender? (Optional)

Male

Female

Transgender

Intersex

Other:

Clear selection

If you need assistance immediately, please include your name and a phone number or email address to reach you at.

Submit

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