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1. Do you know someone with special need?
 
Yes
 
No
 
 
 
2. Kindly select the appropriate information about the person with special need:
Age:
 
1-5 years
 
5-10 years
 
10-15 years
 
15-20 years
 
20+ years
 
 
Gender
Male
Female
 
 
3. What is his/her education level?
 
Primary school
 
Secondary school
 
High School or above
 
Does not go to school
 
 
 
4. What is his/her Intelligence quotient (IQ)?
 
Genius
 
Superior
 
Average
 
Below Average
 
 
 
5. What kind of impairment(s) does he/she suffer from? Select more than one if needed.
 
Learning Disability
 
Autism Spectrum Disorder (ASD)
 
Attention Deficit Disorder (ADD)
 
Obsessive Compulsive Disorder (OCD)
 
Visual/ Hearing/ Speech impairment
 
Other
 
 
 
 
Comment:
   
 
 
Please rate how strongly you agree/disagree with the following statements.
Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
Our service played a key role in increasing your business results
The cost of our service is worth the benefits achieved
We achieved the pre-established targets/goals
We understand the needs of your company
We are thorough in planning and execution
 
 
Comment:
   
 
 
 
Do you have any suggestions for improvement?
   
 
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