Did the assessor clearly explain the nature and purpose of today’s assessment?*YesNo Please explain: Did the assessor conduct himself/herself in a professional manner?*YesNo Please explain: Were you provided with the opportunity to present all of your concerns and respond to all questions from the assessor during the assessment?*YesNo Please explain: Prior to this assessment did you receive a reminder call?*YesNo If transportation services were arranged to get you to and from the assessment were they on time and courteous?*YesNoNo Transportation Service Required Please explain: If interpreter services were used during your assessment were they effective in assisting you to communicate with the assessor?*YesNoNo Interpreter Services Required Please explain: Do you have any further comments regarding today’s assessment? Do you feel that you have had adequate information provided to you to accurately conclude your assessment opinion?*YesNo If you wish to be contacted by a member of management regarding any feedback you may have and/or to lay a formal complaint, please indicate “YES” and complete the following section: *YesNo Date of Assessment:* ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 Assessor Name:* Your Name: Your Email: Thank you for taking the time to complete this questionnaire. Please submit the survey at your earliest convenience to Evolve via E-mail: firstname.lastname@example.org Fax: 519-432-7522 Mail: 301 - 620 Colborne Street, London, ON, N6B 3R9 If you wish to file a formal complaint please contact us. If a response is requested, we will respond within 7 business days of receipt.