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  1. Surveys
  2. 2015
  3. April
  4. P
  5. Please Evaluate Us Sample
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Exit Survey
 
 
Your feedback allows this center to improve to better meet the needs of our community.  Comments may be used, anonymously, to promote the center to others.
 
 
 
Name (optional):
   
Date of Birth (optional):
   
 
 
 
Select the statement which best applies:
 
This is my first visit.
 
I have been here before.
 
 
Thinking about your visit today, please rate your agreement with the following statements:
Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
The Staff listened to me.
The Staff encouraged me.
The Staff did not pressure me.
The information I received was helpful.
I was not "lectured" or criticized.
 
 
 
Please explain how we did or did not meet your expectations:
   
 
 
 
Would you recommend this center to a friend?
 
Yes
 
No
 
 
Thinking about your visit today, how would you rate your overall experience at this center? 
 
 
 
 
Please tell us if there is anyway we can help you or pray for you:
   
 
Thank you for evaluating us!
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