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Client Survey
First Name
Last Name
Relationship to Client (non-client)
Your email
1. My caregiver provides the services according to my care plan/goals.
1. My caregiver provides the services according to my care plan/goals.
2. I feel I can make changes to and have input in my care and services.
2. I feel I can make changes to and have input in my care and services.
3. Caregiver and staff are respectful and have treated me appropriately
3. Caregiver and staff are respectful and have treated me appropriately
4. I am satisfied with the care and services I receive from my caregiver.
4. I am satisfied with the care and services I receive from my caregiver.
5. Caregivers treat my personal property with care and respect.
5. Caregivers treat my personal property with care and respect.
6. I feel my concerns are handled quickly and I am satisfied.
6. I feel my concerns are handled quickly and I am satisfied.
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Thanks for your feedback!
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