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1. Please rate the quality of the services you received from us:
Excellent
Good
Fair
Poor
2. Please rate the information we provided on our website:
Excellent
Good
Fair
Poor
3. Please rate our staff in terms of efficiency:
Excellent
Good
Fair
Poor
4. Please rate our responsiveness to feedback:
Excellent
Good
Fair
Poor
5. Please rate your overall experience with our services:
Excellent
Good
Fair
Poor
6. Please rate friendliness, consideration, politeness, and respectfulness:
Excellent
Good
Fair
Poor
7. Please rate promptness, dependability, efficiency:
Excellent
Good
Fair
Poor
8. Do you feel your needs/wants are being met & are being provided, in accordance with what was agreed upon?
Yes
No
9. Was a personal Service Plan developed & implemented?
Yes
No
10. Were you advised who you/your representative/family may contact should you wish to speak to someone other than your Home Care Worker(s)?
Yes
No
11. Would you use our services in the future?
Yes
No
12. Would you recommend us to others?
Yes
No
Reason:
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