Family Satisfaction Survey

HomeCare Family appreciates you taking the time to complete this Family Satisfaction Survey. Your feedback will help us to meet your expectations concerning the quality of our service. (Note: Provision of identification information is optional.)

Date of Survey

Name of Client

Authorized Family Rep

Relationship to the Person Receiving Care

Why did you choose HomeCare Family over other agencies?

What do you like most about our services?

Organization and Administration

Were you advised who would be supervising your caregiver(s)?

Were you introduced to, or made aware of the caregiver(s) assigned to you, prior to commencement of service?

How well are the caregivers matched with your needs and preferences?Rating scale 1 - 5, with 5 being the best

What do you like/love about your caregiver?

What concerns, if any, do you have about your caregiver(s)?

Evaluation

How would you rate the overall quality of service you receive?

Excellent Good Fair Poor

How can we as, HomeCare Family improve your satisfaction?