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2. Eastside Fire & Rescue’s C.O.R.E. team is committed to connecting individuals with the most effective and helpful human resources and services. The team pays close attention to ensure that they are meeting the needs of each client and are always looking for feedback or suggestions to continue providing the best assistance possible.   

4. Client Name (Not Required)
5. Client's City of Residence (Not Required)
7. 1.) I am satisfied with the service provided to me by the CORE team.*

   On a scale from 1-5, with 1 indicating "Strongly disagree with the statement" and 5 indicating "Strongly agree with the statement", please rank your experience with the CORE team in relation to each statement. 

   1. 1 (Strongly Disagree)
   2. 2 (Somewhat Disagree)
   3. 3 (Neutral)
   4. 4 (Somewhat Agree)
   5. 5 (Strongly Agree)
   6. N/A
9. Share any details you'd like:
11. 2.) My Care Coordinator focused on what was important to me.*

    On a scale from 1-5, with 1 indicating "Strongly disagree with the statement" and 5 indicating "Strongly agree with the statement", please rank your experience with the CORE team in relation to each statement.

    1. 1 (Strongly Disagree)
    2. 2 (Somewhat Disagree)
    3. 3 (Neutral)
    4. 4 (Somewhat Agree)
    5. 5 (Strongly Agree)
    6. N/A
13. Share any details you'd like:
15. 3.) What referrals (if any) did you receive from the CORE team? Check all that apply. *

    1. Medical Providers
    2. In-home caregivers
    3. Assisted living/adult family home facility
    4. Mental health provider
    5. Food resources
    6. I did not receive referrals
    7. Something else: (Please explain below)
17. Other referrals that I received include:
19. 4.) I am satisfied with the clarity of the information and resources provided by the CORE team.*

    On a scale from 1-5, with 1 indicating "Strongly disagree with the statement" and 5 indicating "Strongly agree with the statement", please rank your experience with the CORE team in relation to each statement. 

    1. 1 (Strongly Disagree)
    2. 2 (Somewhat Disagree)
    3. 3 (Neutral)
    4. 4 (Somewhat Agree)
    5. 5 (Strongly Agree)
    6. N/A
21. Share any details you'd like:
23. 5.) What was most beneficial about your experience? Check all that apply.*

    1. Talking to the care coordinator
    2. Referrals from the care coordinator
    3. Advocacy with medical or other providers from care coordinator
    4. EMT/medical assistance from a firefighter
    5. Something else: (Please explain below)
25. What was most beneficial to me was:
27. 6.) Do you have any feedback or suggestions for the CORE team to help better serve our clients?
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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