Customer Satisfaction Survey Caregiver Services

Caregiver Services

1. Overall, how satisfied or dissatisfied were you with our company?

2. Which of the following words would you use to describe our caregivers?

Reliable Caring Useful Outstanding Average Poor Quality Unreliable Useless

If you choose Average, Poor Quality, Unreliable, and/or Useless, please provide your comments/suggestion.

3. How would you rate the quality of our care?

If you choose Neither high nor low quality, Low quality, and/or Extremely poor quality, please provide your comments/suggestion.

4. Do you feel your privacy, dignity and personal needs were met?

If you choose Somewhat and/or No, please provide your comments/suggestion.

5. Would you recommend our services to your friends/family?

If you choose No at survey number 5, please provide your comments/suggestion.

6. Do you feel the care manager and or office staff were available to you as needed?

If you choose No at survey number 6, please provide your comments/suggestion.

We value your suggestions/comments. Please make additional comments, concerns, or suggestions.

Date of this survey

Please type your name and your email address.

Thank you for your trust in our services.