Satisfaction Survey

Survey Instructions
Please answer each question by choosing the answer that best describes your experience and/or your loved ones experience while under our care.

Answer all the questions that apply to you or your loved one by checking the box to the left of your answer. There is a space for comments at the bottom.

Facility:
select
Name:
Email Address:  
Admission

How would you rate your satisfaction with the admissions process?

Was the admission paperwork and services explained clearly?


Room

How would you rate the cleanliness of your room?

Was everything provided by the facility in your room operational?


Maintenance

How would you rate the skill and promptness of the maintenance staff?

Is the maintenance staff friendly and courteous?


Nurses

Has the nursing staff been able to explain care procedures clearly?

Has the nursing staff responded to concerns and ideas and treated you with dignity?


Nurses Aides

Have the nurse's aides and staff been able to explain care procedures clearly?

Have the nurse's aides responded to concerns and ideas and treated you with dignity?


Housekeeping

Level of odor control in the facility:

Quality of your laundry services:


Activities

Are there a large variety of recreational, educational, and religious activities available to you?

Is the staff responsive to you, your loved ones, and other residents when participating in activities?


Dietary

How would you rate the quality of our dietary services?

Food is served hot and fresh?


Finances

Has there been a clear explanation of fees and procedures?

How would you rate the services of the business office?


Miscellaneous

How have the staff treated your visitors?

How did you hear about us?

If Other, please specify



Additional Comments