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Submission: On January 21 via manual from IN — Scanned from DE
Submission: On January 21 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
Name: surveyForm — POST
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<div class="questions clearfix">
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<span class="required-asterisk notranslate"> * </span>
<span class="user-generated notranslate
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<span class="radio-button-label-text question-body-font-theme user-generated "> Counseling Support </span>
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<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-532659159">
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<span class="radio-button-display ">
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<span class="radio-button-label-text question-body-font-theme user-generated "> Work-Life Services (i.e. Child Care, Elder Care, Daily Living, Financial, or Legal Referrals) </span>
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<h4 id="question-title-532659160" class="
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<span class="required-asterisk notranslate"> * </span>
<span class="user-generated notranslate
"> Overall, how satisfied are you with the help you received?</span>
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<span class="radio-button-label-text question-body-font-theme user-generated "> Very satisfied </span>
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<span class="radio-button-label-text question-body-font-theme user-generated "> Satisfied </span>
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<span class="radio-button-label-text question-body-font-theme user-generated "> Neutral </span>
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<span class="radio-button-display ">
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<span class="radio-button-label-text question-body-font-theme user-generated "> Dissatisfied </span>
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<span class="radio-button-label-text question-body-font-theme user-generated "> Very dissatisfied </span>
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<span class="required-asterisk notranslate"> * </span>
<span class="user-generated notranslate
"> Please rate each statement below regarding your experience with the specialist throughout the initial call.</span>
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<td style="width:13.333333333333334%;" class="matrix-col-label question-body-font-theme user-generated"> Agree </td>
<td style="width:13.333333333333334%;" class="matrix-col-label question-body-font-theme user-generated"> Neutral </td>
<td style="width:13.333333333333334%;" class="matrix-col-label question-body-font-theme user-generated"> Disagree </td>
<td style="width:13.333333333333334%;" class="matrix-col-label question-body-font-theme user-generated"> Strongly disagree </td>
<td style="width:13.333333333333334%;" class="matrix-col-label question-body-font-theme user-generated"> N/A </td>
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<span class="matrix-row-label question-body-font-theme user-generated"> The specialist was courteous and empathetic. </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> Strongly agree </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> Agree </span>
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</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> Neutral </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> Disagree </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> Strongly disagree </span>
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<span data-position="5" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist was courteous and empathetic.</span> N/A </span>
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<span class="matrix-row-label question-body-font-theme user-generated"> The specialist provided me support aligned with my needs. </span>
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<td class="touch-sensitive" col="0">
<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-532659166">
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<span data-position="0" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> Strongly agree </span>
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<span data-position="1" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> Agree </span>
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<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-532659166">
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<span data-position="2" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> Neutral </span>
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</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> Disagree </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> Strongly disagree </span>
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<span data-position="5" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The specialist provided me support aligned with my needs.</span> N/A </span>
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<span class="matrix-row-label question-body-font-theme user-generated"> The resources I received from the specialist helped me handle my issue. </span>
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<td class="touch-sensitive" col="0">
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<span data-position="0" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> Strongly agree </span>
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<span data-position="1" class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> Agree </span>
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</span>
<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> Neutral </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> Disagree </span>
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<span class="radio-button-label-text question-body-font-theme user-generated ">
<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> Strongly disagree </span>
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<span class="smusr_radio-row-text">The resources I received from the specialist helped me handle my issue.</span> N/A </span>
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* Dansk * Deutsch * English * Español * Español (Latinoamérica) * Filipino * Français * Indonesia * Italiano * Kiswahili * Magyar * Melayu * Nederlands * Norsk * Polski * Português * Português (Brasil) * Română * Slovenčina * Slovenščina * Suomi * Svenska * Tiếng Việt * Türkçe * Čeština * Ελληνικά * Български * Русский * Српски * עברית * العربية * සිංහල * ไทย * 中文 * 日本語 * 한국어 English SATISFACTION SURVEY Dear Participant, Thank you for taking the time to complete our survey. Your comments are very important to us. Your honest feedback will be helpful as we continue to grow and to improve the quality of our services. QUESTION TITLE * PLEASE INDICATE THE MOST RECENT SERVICE USED: Counseling Support Work-Life Services (i.e. Child Care, Elder Care, Daily Living, Financial, or Legal Referrals) QUESTION TITLE * OVERALL, HOW SATISFIED ARE YOU WITH THE HELP YOU RECEIVED? Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied QUESTION TITLE * PLEASE RATE EACH STATEMENT BELOW REGARDING YOUR EXPERIENCE WITH THE SPECIALIST THROUGHOUT THE INITIAL CALL. Strongly agree Agree Neutral Disagree Strongly disagree N/A The specialist was courteous and empathetic. The specialist was courteous and empathetic. Strongly agree The specialist was courteous and empathetic. Agree The specialist was courteous and empathetic. Neutral The specialist was courteous and empathetic. Disagree The specialist was courteous and empathetic. Strongly disagree The specialist was courteous and empathetic. N/A The specialist provided me support aligned with my needs. The specialist provided me support aligned with my needs. Strongly agree The specialist provided me support aligned with my needs. Agree The specialist provided me support aligned with my needs. Neutral The specialist provided me support aligned with my needs. Disagree The specialist provided me support aligned with my needs. Strongly disagree The specialist provided me support aligned with my needs. N/A The resources I received from the specialist helped me handle my issue. The resources I received from the specialist helped me handle my issue. Strongly agree The resources I received from the specialist helped me handle my issue. Agree The resources I received from the specialist helped me handle my issue. Neutral The resources I received from the specialist helped me handle my issue. Disagree The resources I received from the specialist helped me handle my issue. Strongly disagree The resources I received from the specialist helped me handle my issue. N/A QUESTION TITLE * IN YOUR INITIAL CALL WITH THE SPECIALIST, WERE YOU REFERRED TO AN EXTERNAL PROFESSIONAL? Yes No Next ( Privacy & Cookie Notice Javascript is required for this site to function, please enable.