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Athens Area Services Survey Form
Athens Area Services Survey Form
Please be as forthcoming as possible in your responses. We appreciate your taking the time to complete this survey.
Name of Service/Service Provide:
Address:
Phone Number:
Email:
Website:
Your Name:
Position:
Your Email:
1. Please select the type of service your business/organization provides to the Athens community:
Medical Services
Dental Services
Counseling Services
Legal Services
Food Services
Retail Services
Other Services
Specializing in:
2. Do you have any services that were specifically developed for lesbian, gay, bisexual and/or transgender individuals? If so, what are they?:
3. How would you rate yourself concerning your knowledge of lesbian, gay, bisexual and transgender issues and concerns? Please comment on the issues that you are aware of:
Little to no Knowledge
Some Knowledge
Average Knowledge
Good Knowledge
Very Good Knowledge
Comments:
4. How would you rate yourself, your staff, and your overall operation concerning your acceptance of lesbian, gay, bisexual and transgender individuals? Please comment:
Very Poor Acceptance
Poor Acceptance
Average Acceptance
Good Acceptance
Very Good Acceptance
Comments::
5. Could your business/organization start providing information, assistance or activities to support lesbian, gay, bisexual and transgender individuals? If so, what?:
6. Please provide any additional comments:
