Consumer Satisfaction Questionnaire - NCRTM

Division of Service to the Blind and Visually Impaired 

Consumer Satisfaction Questionnaire 

Please help us improve our program by answering some questions about the 

services you have received from Service to the Blind and Visually Impaired. We 

are interested in your honest opinions, whether they are positive or negative. 

Please answer all of the questions. We also welcome your comments and 

suggestions for improvement of the rehabilitation program. Thank you, we 

appreciate your help. 

CIRCLE YOUR ANSWER: 

1. How would you rate the quality of service you received? 

4 3 2 1 

Excellent Good Fair Poor 

2. Did you get the kind of service you wanted? 

1 2 3 4 

No, definitely not No, not really Yes, generally Yes, definitely 

3. To what extent has our program met your needs? 

4 3 2 1 

Almost all of my Most of my needs Only a few of my None of my needs 

needs have been have been met needs have been have been met 

met met 

4. If a friend were in need of similar help, would you recommend our program to 

him/her? 

1 2 3 4 

No, definitely not No, I don’t think so Yes, I think so Yes, definitely 

5. How satisfied are you with the amount of help you received? 

1 2 3 4 

Quite Indifferent or Mostly satisfied Very satisfied 

dissatisfied mildly dissatisfied

6. Have the services you received helped you to deal more effectively with your 

problems? 

4 3 2 1 

Yes, they helped Yes, they helped No, they really No, they seemed to 

a great deal somewhat didn’t help make things worse 

7. In an overall, general sense, how satisfied are you with the service you received? 

4 3 2 1 

Very Mostly Indifferent Quite 

satisfied satisfied mildly dissatisfied dissatisfied 

8. If you were to seek help again, would you come back to our program? 

1 2 3 4 

No, definitely not No, I don’t think so Yes, I think so Yes, definitely 

COMMENTS & SUGGESTIONS FOR IMPROVEMENT: 

__________________________________________________________ 

Part II 

1. Were you a full partner in the process to determine your employment goal 

and services to be provided? 

1 2 3 4 



2. Do you feel that the services provided by your counselor were necessary to 

obtain or keep your employment? 

4 3 2 1 

Yes, they helped Yes, somewhat No, not really No, they had 

a great deal no effect 

COMMENTS & SUGGESTIONS FOR IMPROVEMENT:

3. Were information and services provided to you in a timely and courteous 

manner? 

1 2 3 4 



4. Did the services help you adjust to your visual impairment? 

4 3 2 1 

Yes, very much Yes, somewhat Not very much No, not at all 


5. How satisfied are you with the employment that you obtained as a result of 

Vocational Rehabilitation Services? 

4 3 2 1 

Very Mostly Indifferent Quite 

satisfied satisfied mildly dissatisfied dissatisfied 


6. How beneficial were services in assisting you in moving from high school to 

work or further education? 

4 3 2 1 

Yes, they helped Yes, somewhat Not much No help 

a great deal helpful help at all 


7. Did skills training (orientation and mobility, home management, computers 

and communications) at the rehab center enhance your independence and 

ability to work? 

4 3 2 1 

Yes, very much Yes, somewhat Not very much No, not at all 


8. Did the classes and training schedule at the rehab center meet your needs? 

1 2 3 4 

No, definitely not No, not really Yes, generally Yes definitely 


9. Were the staff at the rehab center knowledgeable in the areas that they 

provided training? 

1 2 3 4 



10. Were your job placement services beneficial in assisting you to prepare 

for and obtain employment? 

1 2 3 4

Consumer Satisfaction Questionnaire - NCRTM

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?