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CRI Consumer Survey

Title DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

How did you learn about CRI? -- Please select -- Advertising Agency Brochure Family/Friend Phone Book Presentation Billboard Newsletter Other

If other, please explain...

How would you rate the services that you receive from CRI? -- Please select -- Extremely Helpful Very Helpful Somewhat Helpful Not Very Helpful Not Helpful At All

What service(s) do you or have you received from CRI? Advocacy Attendant Care Home Modification Information Referral Trainings Expansions Programs Assistive Technology Accessibility Education Adult Autism Waiver Other

If other, please explain...

How would you rate CRI's commitment and understanding of your needs? -- Please select -- Excellent Good Satisfactory Fair Poor

Please explain the reason for your answer...

Will you use or refer individuals to CRI's services in the future? -- Please select -- Very Likely Maybe Never

What issues or concerns would you like to see CRI address in the future? Healthcare Housing Accessibility Autism Services Adult Day Care Services Transportation Services Other

If other, please explain...

How would you rate the CRI staff and organization as a whole? -- Please select -- Friendly Knowledgeable Average Varies Poor

How would you rate CRI's website? -- Please select -- Excellent Good Satisfactory Fair Poor

Any additional comments regarding the staff, services, or communication mediums associated with CRI...