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  2. 2014
  3. April
  4. E
  5. Exit Survey
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Questions marked with an * are required Exit Survey
 
 
* How did you hear about us?
 
Radio
 
Website
 
Internet search
 
Social media (Facebook or Twitter)
 
Referral from a friend
 
Other
 
 
 
* How satisfied are you with our services?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
 
 
Please rate the following:
We come to you to sign you up
We locate a treatment center for you
We schedule treatment appointments for you
We talk to insurance companies, doctors, and police so you don't have to
We keep you updated on your case
We got you the most possible for your case
Our intake staff
Our case managers
Our negotiators
Our customer service in general
 
 
 
* What do we need to improve on?
   
 
 
 
* Would you recommend us to others?
 
Yes
 
No
 
 
 
* If no, please explain why:
   
 
 
 
* What is your gender?
 
Male
 
Female
 
 
 
* What is your age group?
 
18-24
 
25-34
 
35-44
 
45-54
 
55-64
 
65+
 
 
 
* What is your average yearly income?
 
less than $19,999
 
$20,000 to $34,999
 
$35,000 to $49,999
 
$50,000 to $64,999
 
$65,000 to $79,999
 
$80,000 to $94,999
 
$95,000 to $109,999
 
$110,000 or higher
 
 
 
* What is your education level?
 
Completed some high school
 
High school graduate (or equivalent)
 
Completed some college
 
Associate degree
 
Bachelor's degree
 
Completed some postgraduate
 
Master's degree (or higher)
 
Other