Agency / Program / Therapist Questionnaire

Agency Information

Approximate number of RSI clients you work with:

Which RSI program(s) do you have contact with? (Check all that apply):
	Apartments	Aberdeen	Clayton	Gary
	Hamilton	Purefoy	Umstead	Quail Roost
	Oleander	Carrboro	Christopher	Main St.
	Shadylawn	Silo	Piney Mtn	Spring Glen
	Life Options	CVLS	Ferrell	Admin

How would you rate RSI’s punctuality for appointments?
How would you rate clients’ dress and grooming?
How would you rate communication with RSI?
How would you rate RSI’s response to your input and suggestions?
How would you rate the quality of the staff you have dealt with?
How would you rate resident/staff interactions?
How knowledgeable is the person who accompanies the clients to appointments/activities?
How would you rate your relationship to RSI?

What other comments or suggestions do you have about the RSI program?