ACT 150 HCBS Participant QA FY 25/26

*1.

Are you able to access your Service Coordinator?

Service Coordinator's name

2.

Does your Service Coordinator treat you with respect?

3.

Is your Service Coordinator helpful to you?

4.

Do you have access to the services you need?

5.

Are you satisfied with your experience with UDS Service Coordination?

6.

On a scale from 1 (poor) to 10 (excellent), rate your overall satisfaction working with UDS:

7.	If you are currently unhappy with the service you're receiving and would like a member of our team to contact you to discuss your concerns, please select "Yes" below.

	Yes No

8.

If yes to the above question, please enter the below identifying information so we can reach out to you.

Name of Participant
Name of Person Completing Survey (if applicable)
Phone Number
Email Address

9.	Additional Comments/Questions

	Remaining characters: 4000