Keystone House, Inc.

Satisfaction Survey

For Friends and Family of Clients Served

 

Keystone House welcomes feedback from our clients' friends, family members and other supporters. Please take a moment to print and complete this survey and mail to:
Marian Langzettel
Keystone House, Inc.
141 East Ave
Norwalk, CT 06851

 

Name of Respondent (optional):___________________

 

Please check the appropriate block:

 

 

Strongly

Agree

Agree

Neutral

Disagree

Strongly

Disagree

N/A

My family member/friend/significant other receives the support he or she needs.

 

 

 

 

 

 

My family member/friend/significant other was able to access services at Keystone in a timely manner.

 

 

 

 

 

 

My family member/friend/significant other has made progress as a result of this program.

 

 

 

 

 

 

My family member/friend/significant other has a better quality of life as a result of this program.

 

 

 

 

 

 

Staff members treat me with respect.

 

 

 

 

 

 

Staff members return my calls promptly.

 

 

 

 

 

 

Staff members believe that my family member, friend etc. can grow, change and recover.

 

 

 

 

 

 

Staff respect my family member’s wishes regarding the amount of family involvement he/she wants.

 

 

 

 

 

 

Staff are sensitive to the cultural/ ethnic background of my family member/friend/significant other.

 

 

 

 

 

 

I would recommend Keystone to other individuals with similar needs.

 

 

 

 

 

 

 

Additional comments:

 

 

Your feedback will be incorporated into Keystone's Quality Assurance Program, and will be used to enhance the services we provide.
Thank you!