Long Term Project Client Survey Long Term Client Survey Long Term Post Project Survey Long Term Post Project Survey Contact Details Name of Client Phone Email Diagnosis I identify my ethnic background as: Please let Home Builders Foundation know what we're doing well and how we can improve so we may provide the best possible service to future clients. Prior to receiving modifications from HBF did you have reason to believe you could NOT stay in your home long-term due to limited access and/or safety?YesNoN/A Strongly Agree Agree Neutral Disagree Strongly Disagree Not Applicable The modifications provided by HBF increased my safety. The modifications provided by HBF increased the safety of my caretaker(s). The modifications provided by HBF improved the quality of life for me and/or others in my household. The modifications provided by HBF increased my accessibility to my community and the things I enjoy. The work done by HBF has created more independence for me. The work done by HBF has created more independence for those in my life. The work done by HBF has impacted my dignity. I would refer a friend or family member to HBF. My overall experience with HBF was positive. How many people (including household members, client, and caregivers) were impacted by the modifications provided by HBF? What was a daily struggle that is now gone thanks to the work that was completed (i.e. showering alone, accessing the sink, leaving the home, etc.) Please provide additional Comments on areas where HBF can improve. Please provide additional Comments on what went well and/or how the modifications by HBF have impacted your life. What are your personal thoughts on the work HBF does in the community? Please provide any updates on what you'be been doing as a result of the modifications made to your home, i.e. back to work, getting outside daily, volunteering my daughter's school, etc. Would you be willing to share your story further on an HBF blog or social media post? If so a staff member may contact you for additional information.YesNo I want to stay connected with HBF in the future.YesNo If you answered Yes for the previous question, please indicate how you would like to be involved.Speaker/Ambassador at an eventProvide HBF with a testimonialBecome a donorCreate a Facebook fundraiserSolicit silent auction items for an eventJoin the Facebook client group Any additional comments you would like to share. Please upload a picture of you. If possible, with your modifications or doing an activity that your modifications made possible. Contact Information
