Customer Satisfaction Survey

We are eager to hear your suggestions on how we can improve the client experience; either through office accommodations, service offerings, or something else. Please complete the fields below. When finished, click "Submit" to share your responses with our team. Thank you!

Name

First

Last

Date of Service/Visit:

Was this the first time you received services from UCHRA?

Yes
No

Do you feel you received fair treatment?

Yes
No

Were you treated with respect and dignity?

Yes
No

If you selected "No" above, please explain:

Did someone explain the process and what would be next regarding the service you received?

Yes
No

If you selected "No" above, please explain:

Did the support or assistance you received help improve your current situation?

Yes
No

Did you call UCHRA for service or did you visit an office?

I called the office
I visited the office

Which county/office location did you receive services from?

If known, please list the name(s) of the staff member(s) who assisted you:

Please include first and last names, if known.

Overall, were you statisfied?

Yes
No

If you selected "No" above, please explain:

How would you rate your visit? *

1 = Poor; 5 = Excellent

Comments/Suggestions

We are eager to learn more about your experience and hear your suggestions on how we can improve the client experience. Please do not include sensitive information here.

How did you learn about UCHRA? *

If you selected "Other" above, please describe: