Central Home Health

Patient Satisfaction Survey

We would like to provide our patients the best possible service. We are interested in your ideas or opinions about our care/services. Please help us to know how we met your needs by completeing this questionaire. Please wait at least a month before filling out.

Patient Satisfaction Survey

Which Services were provided? Please click all that apply

Nursing

Speech Therapy

Home Health Aid

Occupational Therapy

Physical Therapy

Medical Social Worker

Do you feel the care you are receiving is helping you recover?

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Were you notified in advance of changes in your visit schedule?

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Do you feel that the staff is considering your needs and your family's needs?

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Was the plan of care discussed in terms you could understand?

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Are the staff members teaching you what you need to know in order to function independently?

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Were your rights and responsibilities explained to you by a staff member during your first visit?

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Were you given an opportunity to ask all your questions?

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Were the staff members courteous?

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Were the staff members competent?

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Were you able to contact agency personnel when needed?

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Were your needs/problems addressed by our agency in a timely manner?

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Would you use this agency again?

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Would you reccomend this agency to friends and relatives?

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Please make comments/suggestions that you might feel will improve our services.

What most impressed you about the agency's care/services?

I would/would not like to discuss my responses further

Name(optional)

Date

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