Patient/ Client Satisfaction Survey - Medical Home Health Services

Patient/Client or Caregiver Name or Initials *

First

Last

Email

Please enter your email, so we can follow up with you.

Date services started

Over what period of time did you receive home health services from our agency?

Date services Ended

please select the services you received or are receiving:

My aide/nurse/ therapist is responsive to my needs *

My aide/nurse/ therapist listens when I talk. *

My privacy/property is respected. *

Did our staff explain your rights and responsibilities as a patient/family member? *

Was the patient and/or the family involved in the decision making regarding the plan of care? *

My aide/nurse/ therapist makes their scheduled visits/shifts. *

Did your nurse, therapist or aide introduced him/herself and explain the plan of care, allowing me and/or my caregiver to ask questions? *

Did our staff give instructions and information in terms you could understand? *

I am informed of any visit/shift changes. *

I know how to contact the office if I have a problem or complaint. *

When I call the office, the staff is courteous and helpful. *

Overall, I am satisfied with the services provided by Medicall Home Health Services, LLC *

I would recommend Medicall Home Health Services, LLC to a family member or friend. *

Comments/Suggestions for Improvement:

Who is or was your attendant/aide/nurse/ therapist? (Please write their name here): *