How long have you been receiving caregiver services including adult daycare for your loved one?

What is your relationship to the person cared for at HIAC?

What kind of caregiver support services have you received? (check all that apply)

Of all the caregiver support services, which one service was the most helpful?

As a result of caregiver services do you (check all that apply):

Overall, how do you rate the caregiver services that HIAC provides?

Would you recommend HIAC services to a friend? If no, why? 

Has our Caregiver Support Services enabled you to provide care for a more extended period of time? 

Does HIAC meet your needs?     

Please rate your satisfaction with our services and add any comments,

Program activities:

Please rate your satisfaction with our services and add any comments,

Participant’s enjoyment:

Please rate your satisfaction with our services and add any comments,

Individualised care:

Please rate your satisfaction with our services and add any comments,

Health monitoring:

Please rate your satisfaction with our services and add any comments,

Communication re: loved one

Please rate your satisfaction with our services and add any comments,

Communication re: general:

Please rate your satisfaction with our services,

Sensitivity to participant’s needs:                  

Please rate your satisfaction with our services,

Safe environment:       

Please rate your satisfaction with our services,

Facility, parking, sidewalks:     

Please rate your satisfaction with our services, 

Covid protocols:

Please rate your satisfaction with our services,

Meals served:

Please rate your satisfaction with our services,

Cleanliness of the facility:

Please rate your satisfaction with our services, 

Professionalism of staff:

Please rate your satisfaction with our services,

Friendliness and courtesy of staff:

Please rate your satisfaction with our services,

Dress attire of all staff:

Extra Services, if applicable,

HIAC-provided transportation:

Extra Services, if applicable,

Showering/personal care:

Extra Services, if applicable,

Saturday daycare services:

Extra Services, if applicable,

Holiday daycare services:

Extra Services, if applicable,

Saturday caregiver respite day:

Extra Services, if applicable,

Caregiver support group:

We are currently open from 7am-5pm Monday-Friday and 8am-4pm on Saturdays and most holidays.

Are you interested in monthly Friday night day care and or Caregiver Pau Hana social?

Are you aware of the Caregiver Respite Day held the third Saturday of each month?      

Are you aware of the Caregiver Respite Day held the third Saturday of each month?      

What other ancillary services would you like to see offered at HIAC?      

What are the top three programs or events you are interested in attending in the next six months?  

What else can HIAC do to help you as you are on the caregiver journey? We appreciate your suggestions and feedback on how we can be a better support to you and your loved one. 

YES! Add my email to my contact information. My email is: 

If you would like to leave your name, phone number, email you can do so here