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Patient Satisfaction Survey
Patient Name
Did our team give you verbal & written information about your rights and responsibilities, tell you how to voice a complaint and show you the 24/7 number with administrator/clinical manager contact information?
Excellent
Good
Average
Fair
Poor
N/A
Did our team review all of your medications with you?
Excellent
Good
Average
Fair
Poor
N/A
Did our team talk to you about safety in your home?
Excellent
Good
Average
Fair
Poor
N/A
Did our team members talk to you about your medical diagnosis, treatments, risks, goals, and progress in terms and language you could understand?
Excellent
Good
Average
Fair
Poor
N/A
Did our physical and/or occupational therapist give you instructions on exercises prescribed?
Excellent
Good
Average
Fair
Poor
N/A
Did our team always let you know when they were coming?
Excellent
Good
Average
Fair
Poor
N/A
Did our team members treat you with respect and kindness?
Excellent
Good
Average
Fair
Poor
N/A
Is there any team member you would like to recognize for outstanding care?
Excellent
Good
Average
Fair
Poor
N/A
Would you recommend our services to other individuals or request our services again?
Yes
No
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