Quality Service Survey for Child Care Services

2. In order to better serve you, we would like to know about your most recent experience with Child Care Services.

   
   

4. How did you hear about us?

   1. Friend
   2. Daycare Center
   3. Workforce Center

   1. Bus Wrap
   2. 2-1-1
   3. Other

6. Please explain if you chose other:

8. 1. How did you contact us?

   1. Phone
   2. Email
   3. In Person

10. 2. Do you feel that you were waited on promptly?
    

    1. Yes
    2. No

12. 
    3. How long did you wait to speak to with someone?

14. 
    

    4. What is the name of the staff person who assisted you?

    -- Select One --AmberBambieBrisaDanielleFelaHeidiJoanJoAnnJordanKarieshaLindaLudiMonicaNancySharonToniSofiaNot sure

16. 
    5. How many times did you have to contact us before you were helped?

    -- Select One --OnceTwiceMore than 2 times

18. 
    6. Were your questions answered to your satisfaction?
    

    1. Yes
    2. No
    3. I am not sure

20. If you answered no, please explain
    

22. 
    7. Did the staff person explain and review your forms with you?
    

    1. Yes
    2. No
    3. Not Applicable

23. 
    8. Did you get the information you needed to help you choose a provider?
    

    1. Yes
    2. No
    3. Not Applicable

25. 
    9. Do you feel that the staff person acted in your best interest?
    

    1. Yes
    2. No
    3. I am not sure

26. 
    10. Do you feel that the staff person is well supervised and well trained?
    

    1. Yes
    2. No
    3. I am not sure

28. If you answered no, please explain
    

30. 
    Please rate the staff person who helped you on the following items:

32. Knowledgeable
    

    1. above average
    2. average
    3. below average
    4. not sure

33. Competent

    1. above average
    2. average
    3. below average
    4. not sure

34. Patient

    1. above average
    2. average
    3. below average
    4. not sure

36. Enthusiastic

    1. above average
    2. average
    3. below average
    4. not sure

37. Listens carefully

    1. above average
    2. average
    3. below average
    4. not sure

38. Friendly

    1. above average
    2. average
    3. below average
    4. not sure

40. Responsive

    1. above average
    2. average
    3. below average
    4. not sure

41. Courteous

    1. above average
    2. average
    3. below average
    4. not sure

43. 
    What suggestions do you have to help us provide better services to you?

45. 
    Please describe your overall experience with Child Care Services.

47. 
    If you would like for someone to contact you about your experience or to follow up with your concerns, please complete the boxes below.

49. 
    Name

50. 
    Phone Number

52. 
    Email Address

53. 
    Best Time to Contact You

55. Thank you for your input.

57. Workforce Solutions of West Central TX /Child Care Services is an Equal Opportunity Employer/Program.
    Auxiliary aids and services are available, upon request, to individuals with disabilities. Relay Texas: 1-800-735-2989 or 1-800-735-2988 (Voice).
    

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60. Email address

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