Request edit access
Customer Feedback Form
We would love to hear your thoughts or feedback on how we can improve your experience of any of our services within the Belmont Healthcare Family.  Please would you kindly take the time to complete the below form and allow us to under your experience of the service - this can be done anonymously if you wish not to include your names then this is perfectly fine...
Sign in to Google to save your progress. Learn more
Name (Optional)
Email (Optional)
1. Please Provide your Information
Family Members Name (Optional)
2. Please Tell us which Care Home you are giving Feedback on *
3. How do you rate the quality of Care provided at for your relative or friend? *
4. How do you rate the cleanliness of the Care home *
5. How do you rate the Friendliness of Staff *
6. How do you rate the Complaints handling process of the care home *
7. How do you rate the overall atmosphere and environment of the care home? *
8. What is your overall impressions of the home from your recent experiences? *
9. What are your thoughts around our communication such as our Newsletters and Social Media Content *
10. How have you found the ease of visitation and seeing your family members during this period? *
9. Are there any features or processes within the home you feel need to be addressed and if so how you feel we can improve? *
10. Please provide any feedback on the home which you wish to take forward as we look to continuously improve? *
11. Please let us know of anyone of our Teams who deserves special mention who you feel we have go above and beyond to perform? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Belmont Healthcare. Report Abuse
Google Forms