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What is your profession?
 
State DIS
 
County DIS
 
Manager
 
Bridge Counselor
 
Surveillance Coordinator
 
Secretary
 
Other
 
 
Please rate the following features of this proposed service based on their importance to you.
Very Important Somewhat Disagree Neutral Somewhat Important Very Important
Flexibility of schedules
Price
Professionalism
Payment plan
Responsiveness
 
 
 
What would be an appropriate price for this service per month/year, if it had all the features mentioned above?
 
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{PRICE RANGE 2}
 
{PRICE RANGE 3}
 
{PRICE RANGE 4}
 
{PRICE RANGE 5}
 
I would not pay for this service
 
 
 
What payment method are you likely to pay with?
 
Cash
 
Check
 
Credit card
 
Debit card
 
Payment plan
 
 
 
What other features you would like to see incorporated into this service?
   
 
 
 
Please provide any additional comments you have about our proposed service.