Satisfaction Survey Form

Please take an opportunity to fill out our survey form below.  Select responses from the drop down menus below. 
 
We appreciate your feedback!


Staff and Administration

Help available for filling out the resident`s paperwork
Suppport provided from social services
 
Staff attends to the resident`s emotional needs
Staff is friendly when you come to visit
Staff treats the resident with kindess and respect
Assistance is available to help the resident complete his or her meal
There is open communication between staff and you
There is appropriate notification in change of condition
Staff respects resident`s privacy
Physical Aspects of Nursing Home

Hallways and public areas are kept odor free
The facility is clean and well maintained
Physical attractiveness of the facility
Activities Available to Residents

Meaningful activities are offered seven days a week
Enough outdoor activities
Clergy visits or religious services
Variety of stimulating activities
Personal Care Provided to Residents

Staff assures that the resident is clean
Laundry system gets the resident`s own clothes back to them
Quality of physician and specialist services meets the resident`s needs
Food and Meals

Food choices are provided at each meal
Quality food, attractive, appetizing and nutritious
Additional Comments:

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