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OPC Area Program Client Satisfaction Survey

We want to hear from you!

Because we value your input, we would like to hear from you regarding your services.

Please take a few minutes to complete this survey. The information you submit will be sent directly to the Client Rights Coordinator and will be kept confidential. We will not share your name or any identifying information unless you give us permission or we are required to do so by State or Federal law (ex. any information received about physical abuse would require us to make a report to the local Department of Social Services). OPC’s Area Quality Improvement Committee, Senior Management and Governing Body will review the aggregate data (meaning no identifying information is included) from these surveys and make recommendations in order to improve the quality of our services.

We will soon make copies of this survey available at local OPC sites, and in the future, we will be sending surveys to a random selection of consumers.

If you would prefer to print this survey and return it, please send it to: Client Rights Coordinator, OPC Area Program, 100 Europa Drive, Suite 490, Chapel Hill, NC 27517

Thank you for your assistance and your feedback.

1. Which OPC program(s) provides your services?

2. How long have you been receiving services?
3. Do any of the following make it hard for you to receive services?
(please select all that apply)
Available appointment times inconvenient
Location of site inconvenient
Transportation problems
Can’t afford the services
Feel that services are not working
Do not like the provider or the services
Afraid someone I know will find out I am getting services
Program does not provide the services I want/need
4. Are there some things you feel are especially good or helpful about your services? If yes, please explain.
5. Does your provider involve you in planning your services?


6. Do you feel like you can complain or make suggestions about your services?


7. If you answered "no" to Question #6 above , what do you feel prevents you from being able to do so?
8. Do you have any specific concerns or complaints about your services? If yes, please explain.
9. If you have concerns/complaints, would you like someone to contact you? If yes, please provide your name and contact information at the end of this survey.


10. Would you recommend OPC to a friend if he/she needed services?


11. Do you have any suggestions for how to improve services at OPC? If so, please explain.
12. Any Other Comments?
CONTACT INFORMATION - OPTIONAL
Last Name:
First Name:
 
Address (Street Number and Name):
City:
State:
Zip Code:
Phone:
Email:

I would prefer to be contacted by:




Please note that any information you submit electronically will not be encrypted or secured and, while unlikely, may be accessed by others. If you would prefer to contact the Client Rights Coordinator directly, please call 919-913-4079.