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Please take a few moments to provide us with your feedback, comments and/or concerns by filling out the following survey.
Please note that all responses will be kept confidential and will not affect the status of your case.

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* 1. Are you filling this survey out regarding IHSS Public Authority services or other IHSS services?
[Public Authority manages approved providers for IHSS recipients who need an in-home caregiver including a provider list]
[IHSS in general handles IHSS applications, IHSS reassessment and Medi-Cal applications]

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* 2. Date of Service / Date of Interaction

Date

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* 3. Staff treated me with respect.

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* 4. Staff was knowledgeable and provided accurate information about the services I needed.

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* 5. Staff gave clear instructions and I understood what was expected of me.

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* 6. My concerns were acknowledged and adequately addressed.

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* 7. Overall, I am satisfied with my customer service experience.

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* 8. If you left a message for a staff member was your call returned in a timely manner?

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* 9. If you received a call back from a staff member how long did it take for you to receive a call?

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* 10. What is your Zip Code?

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* 11. We appreciate your comments/suggestions:
While this information is not shared with third parties, and should remain confidential, please do not provide otherwise confidential information such as: medical information, financial information, date of birth, driver’s license information, etc.

If you have specific information or a specific incident that you would like to share, please call our office and ask to speak with a manager.

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