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Program Reporting

Programs' Survey

First Name *
Last Name *
Month
/
Day
/
Year
Score the following 1-5, 5 being highest and 1 being the lowest.
Ordering: Does the product choice availability meet your program's need?
Delivery: Have orders been delivered and scheduled to satisfaction?
Staff: Do you feel that staff are friendly and helpful?
Services: Are you satisfied with the quality of services offered?
Follow Up: Do You feel your concerns & questions are handled quickly?