SIS™ Assessment Satisfaction Survey

Respondant Information
Your Name:		Focus Individual's Name:
Your Phone: Example: xxx-xxx-xxxx		Best Time for a Follow Up Call:

Experience Ratings
Please rate the following about your experiences during this assessment:
	No	Slightly, could have done much better	Fair, made an effort but didn't meet my needs	Good	Great
The interview was scheduled at a time and date convenient to those of us participating.
The assessor explained the interview process in a way that was clear and easy to follow.
The assessor treated me/us with dignity and respect.
The assessor listened to me/us and was interested in what we had to say.
The assessor spent time learning about our needs, goals, and desires.