Patient/ Client Satisfaction Survey

Patient/Client or Caregiver Name or Initials

First

Last

Date services started

Date services ended

please select the services you received or are receiving:

Skilled Nursing

Physical Therapy

Personal Care services

Occupational Therapy

Speech Therapy

Wound Care

Psych Nursing

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):

N/A

Prefer not to list

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