* = Required Information

Did our nurse treat you gently during the visits?

YesNo

Did our staff treat you with Courtesy and respect?:

YesNo

Did our staff explain/inform you on the care and services?

YesNo

Did our staff inform you of the arrival time?

YesNo

Was our nurse easy to understand?

YesNo

Did our nurse listen to what you have to say carefully?

YesNo

Did you get help when you contacted our office?

YesNo

Did you get help on time?

YesNo

Did our staff discuss Home safety with you?

YesNo

Did our nurse see and discuss your medications?

YesNo

Did our nurse discuss pain with you?

YesNo

Did the nurse discuss the purpose of medication, when to take medication and the side effects of medications you are taking?

YesNo

1. Please rate the quality of the services you received from us:

ExcellentGoodFairPoor

2. Please rate the information we provided on our website:

ExcellentGoodFairPoor

3. Please rate our staff in terms of efficiency:

ExcellentGoodFairPoor

4. Please rate our responsiveness to feedback:

ExcellentGoodFairPoor

5. Please rate your overall experience with our services:

ExcellentGoodFairPoor

6. Would you recommend us to friends and family?

YesNo
Reason:

Security Code *