Adult Advocacy – Provider Satisfaction Survey

Purpose: Gather feedback from partners (group homes, facility staff, medical/behavioral providers, county staff, vocational/day program staff, etc.) to improve collaboration and client outcomes. This survey is voluntary and does not affect services.

Adult Advocacy – Provider Satisfaction Survey

Purpose: Gather feedback from partners (group homes, facility staff, medical/behavioral providers, county staff, vocational/day program staff, etc.) to improve collaboration and client outcomes. This survey is voluntary and does not affect services.
Client Name (Optional)
Provider Name (Optional)
Provider Type (Check One or More)
Consent & Privacy
Participation is voluntary. You may skip any question or stop at any time without affecting services. You may complete this survey anonymously. Identifying information is optional. Feedback is used for program improvement, staff training, and quality reporting. Summaries may be shared with courts/county or providers; names/organizations are not used unless permission is given. Only authorized Adult Advocacy staff (including the Program Director) may view individual responses. Please do not include client protected health information (PHI) in this form. Use approved secure channels for PHI. Survey responses are stored securely and retained for up to 24 months (or per agency policy).
Consent & Privacy

Scale (satisfaction rating):

1 – Strongly Disagree: This is rarely or never demonstrated; significant improvement is needed. 2 – Disagree: This is inconsistently demonstrated; there are notable gaps or concerns. 3 – Neither Agree nor Disagree: This is sometimes demonstrated but inconsistent or unclear. 4 – Agree: This is consistently demonstrated and meets expectations. 5 – Strongly Agree: This is consistently and clearly demonstrated; a strength of the program.
Scale:
1 – Strongly Disagree 2 – Disagree 3 – Neither Agree nor Disagree 4 – Agree 5 – Strongly Agree N/A - Not applicable
Adult Advocacy staff treat clients and providers with respect and professionalism.(Required)
Communication from Adult Adovacy is clear and timely.(Required)
Guardian responsibilities are applied in ways that support the client’s voice, rights, and least‑restrictive choices.(Required)
Adult Advocacy coordinates well with the care team and follows through.(Required)
Documentation (consents, ROIs,) are completed and provided in a timely manner.(Required)
Adult Advocacy is responsive during urgent issues (including pager/on-call).(Required)
Staff show practical understanding of guardian responsibilities (e.g., consent, least‑restrictive decisions, required court reporting).(Required)
Conflicts are addressed constructively and solutions are practical.(Required)
Overall, Adult Advocacy is a reliable partner.(Required)
How do you prefer Adult Advocacy staff to communicate with you for routine matters?

Consent (optional, please read below)

If you indicated that we may contact you regarding your feedback or use your comments as a quote, please complete the section below. Thank You!
Questions about this survey or privacy? Contact the Adult Advocacy Program Office.
111 Market St PO Box 379 Winona, MN 55987 | Phone: 507-454-2270 ext. 233