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  2. 2017
  3. April
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  5. Satisfaction
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Questions marked with a * are required Exit Survey
 
 
* Name of the Client
   
 
 
 
Today's Date
MonthDayYear
  
 
 
Your Name and Contact Information
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
Email Address : 
 
 
 
Do you want to be added to Disability Rights NC's eNews list? You will receive our eNews once a month.
Yes
No
 
Thank you for contacting Disability Rights North Carolina for assistance. As the official protection and advocacy agency in North Carolina, we protect and advocate for the civil and legal rights of North Carolinians with disabilities under federal and state law.


To help us better serve you, we would like to know what you thought about the services we provided. Your answers are very important to us and will remain confidential.
1. How valuable was the support or representation Disability Rights NC provided?
Not at all valuable
Not very valuable
Somewhat valuable
Valuable
Very valuable
 
 
2. Overall, how satisfied are you with the advocacy or legal representation provided?
Very dissatisfied
Somewhat dissatisfied
Neutral
Somewhat satisfied
Very satisfied
 
 
What could Disability Rights NC have done to better serve you?
   
 
 
Do you agree or disagree with this statement:
After working with Disability Rights NC, I have a better understanding of my legal rights or the rights of my family members under laws pertaining to persons with disabilities.
Agree
Disagree
 
 
 
Any additional comments about our work?
   
 
 
Would you contact Disability Rights NC again if you needed assistance?
Yes
No