Patient & Family Survey
Greetings! As part of a continuing effort to maintain the highest quality care and customer service, we would appreciate it if you could fill out this quick survey! This is for internal purposes only and we will not share your information with anyone.
Email address *
1. How likely is it that you would recommend our facility to a friend, family member or colleague? *
Not likely
Highly Likely
2. How satisfied were you with our facility overall? *
Totally unsatisfied
Highly satisfied
3. Which of the following words would you use to describe our services. Select all that apply. *
Required
4. How well did our facility meet your/the patient's needs? *
5. How would you rate the quality of rehab and nursing care? *
6. How would you rate the quality of our food services? *
7. How attentive has the nursing staff been in meeting your/the patient's needs? *
8. How long have you/friend/family member been a patient or resident? *
9. How would you rate the responsiveness of the staff to your questions or concerns? *
10. Please comment below if you would like to provide a testimonial for our website or marketing materials. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms