River Valley Home Care Inc

Client Satisfaction Survey

We would like to hear all about your recent experience with our company. Please take a moment to think about the caregivers, the supervisors, and the people on the phone with whom you have had contact.

1. How long have you been receiving service? ( Please check one )

0-3 months

3-6 months

6-12 months

1-2 years

More than 2 years

2. Service received ( check all applicable )

Nursing	Home Health Aide	Physical Therapy	Speech Therapy
Homemaking		Occupational Therapy

Select the number that corresponds with your evaluation.		5	4	3	2	1
		Always	Usually	Sometimes	Rarely	NA

3.	When you had contact with us in person or via the telephone:
	a. Were your questions and concerns answered adequately?
	b. Did we listen; show interest and genuine concern for you?
	c. Were telephone calls answered promptly?

4.	When our caregiver(s) was in your home:
	a. Were you treated with compassion and concern?
	b. Were your needs met to your satisfaction?
	c. Was our caregiver prompt and dependable?
	d. Did you feel secure and confident in our ability to care for you?

5.	When you started services or received our bill:
	a. Were you able to contact the appropriate person on the phone?
	b. Were our charges clearly and fully explained?
	c. Were invoices and statements clear and easy to understand?
	d. Were our billing department people courteous and helpful?

6. How would you rate our services overall?

Excellent

Above Average

Average

Below Average

Not Acceptable

7. Comments/Concerns

8. Do you understand your/your family rights in home care?

9. Are you asked to participate in care/family conferences at least every 62 days?

Name (optional):

Date:

Thank you for the opportunity to serve you and for helping us continually improve.

Committed & Professional Home Health Care State Licensure Medicare Certified