Assessment: Customer Satisfaction Survey


Survey responses are anonymous; however, you can choose to be contacted by providing the information at the end of the form.

Q 1.1. What county do you live in?

Q 1.2. Which NEMCSA program(s) did you work with over the last year? Select all that apply.













Q 1.3. Select the correct word to describe your overall family situation for each timeframe.

Successful Stable Safe At Risk In Crisis
Before working with NEMCSA:
After working with NEMCSA:

Q 1.4. Indicate whether you agree, disagree, or have no opinion on the following statements.

Agree No opinion/ Not Applicable Disagree
Staff treated me with dignity and respect.
Staff provided information in a way that was easy to understand.
Staff included my input in decisions related to my services and programs.
Staff were knowledgeable and helpful in completing paperwork and explaining program requirements.
NEMCSA staff connected me with additional programs and resources, if needed.
I enjoyed interacting with NEMCSA staff.

Q 1.5. The services provided by NEMCSA helped me meet my needs.

Q 1.6. Explanation

Q 1.7. Rate your experience with NEMCSA.

Stories shared here may be shared publicly without any identifying information.

Q 1.8. Tell us one thing NEMCSA programs and services have done for you and/or your family. (Optional)

Q 1.9. Share suggestions to help NEMCSA improve programs and services.

Q 1.10. Would you recommend NEMCSA to others?

Q 1.11. Would you like someone from NEMCSA to contact you?


Q 1.12. Provide your name and contact information (email and/or phone number) as well as preferred time to call.