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Client Satisfaction Survey

SURVEY

We are interested in rendering quality care to our clients and would appreciate your input by answering the following questions. Thank you for your evaluation.

We were privileged to participate in the care of the above client. We are interested rendering quality care to our clients and would appreciate your input by answering the following questions. Your evaluation will allow us to be more responsive to future client/family needs.


1. What services(s) did you receive from the Agency?

Nursing Physical Therapy
Occupational Therapy Speech Therapy
Home Health Aide Medical Social Worker

2. Were you satisfied with the care you received?

Yes    No

If not, why?


3. Did you participate in your plan of care?

Yes    No

4. Did you receive and understand your "Bill of Rights" including the toll free "Hotline"
number that you could call if any problems were not resolved by the Agency?

Yes    No

5. Did the staff visit as frequently as they stated they would when they started your services?

Yes    No

6. Did you feel comfortable asking staff questions regarding your health?

Yes    No

7. Did the staff person visit at a mutually agreeable time?

Yes    No

8. If you had therapy, were exercise instructions given to you in a clear,
written manner that you could easily understand?

Yes    No    N/A

9. Did you feel that you were discharged appropriately?

Yes    No

10. Would you use the services of the Agency in the future?

Yes    No

If not, why?


Suggestions for improvement: