Client Satisfaction Survey main Name First Last Email(Required) Date of Service Initiation (Approximate) MM slash DD slash YYYY What duration was the service provided? Hours : Minutes AM PM AM/PM What type of services did you or the client primarily receive? Personal Care (e.g., bathing, dressing) Companionship/Social Activities Light Housekeeping/Meal Preparation Medication Management/Reminders Respite Care Skilled Nursing Care Transportation Were the steps to initiating services, our rates and expectations clearly communicated?YesNoWere we able to meet your home scheduling requests?YesNoWere we able to meet your home healthcare requests?YesNoOverall, how satisfied are you with the Caregiver provided by Angels There For You? 5 stars services 4 stars services 3 stars services 2 stars services 1 5 star services Which of the following service areas do you feel Angels There For You excels in? Quality of Care Staff Communication Scheduling Flexibility Administrative Support Value for Money Client Appreciation Gifts Community Involvement and Support How would you rate the value for money of the services received? 5 stars services 4 stars services 3 stars services 2 stars services 1 5 star services If you needed to contact the agency outside of regular business hours, were you able to reach someone promptly? Yes, always Sometimes No, I was not able to reach anyone I have not needed to contact the agency outside of hours Which factor was most important to you when choosing Angels There For You?Reputation and ReviewsRange of Services OfferedCost/PricingStaff AvailabilityReferral from a Professional/FriendHow would you rate the overall quality of communication from the office staff (excluding caregivers)? 5 stars services 4 stars services 3 stars services 2 stars services 1 5 star services Please rate your satisfaction with the following aspects of our service: Professionalism of caregivers Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Punctuality and reliability of caregivers Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Caregiver's communication skills Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Caregiver's attentiveness to needs Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Someone can help you when you contact the office Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Agency's responsiveness to scheduling changes or concerns Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Ease of contacting the agency staff Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied 90872
