Instructions - The following questions can be answered by clicking the buttons preceding Yes, No, or N/A if you feel that a question is not applicable to you. A space is provided below each question for additional comments. Please let us know if there is something you feel we have left out. If you wish to be contacted regarding any of your responses indicate this below and provide us with your phone number in the "Recommendations/Additional Comments" section. All suggestions and comments are appreciated. Thank you for taking the time to respond.
Consumer
Staff
Advocate/Friend
Family Member/Guardian
Other
Service(s) Received: (please mark all that apply.)
Preschool
Day Habilitation
Community Habilitation
UPK
IRA
Speech Therapy
Physical Therapy
Occupational Therapy
Other
Services and Planning:
1. Are you satisfied with the services and supports you receive from the E. John Gavras Center?
Yes
No
N/A
Comments:
2. Are you provided with a healthy, clean and safe environment?
Yes
No
N/A
Comments:
3. Are you receiving the services you want?
Yes
No
N/A
Comments:
4. Do you feel that you are involved in the development of your program?
Yes
No
N/A
Comments:
5. Are you treated with respect?
Yes
No
N/A
Comments:
6. Are you aware of your rights as an individual receiving services from the Gavras Center?
Yes
No
N/A
Comments:
7. Do you feel that your personal information has been handled respectfully and in confidence?
Yes
No
N/A
Comments:
8. Do you know who to contact with a concern or complaint?
Yes
No
N/A
Comments:
9. Are your problems/concerns responded to in a timely manner?
Yes
No
N/A
Comments:
10. What do you like best about your involvement with the E. John Gavras Center?
