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LEONE HOMEHEALTH CARE AGENCY INC. PATIENT PERCEPTION/SATISFACTION SURVEY
You have recently received services from LEONE HOMEHEALTH CARE AGENCY INC. We want to insure that we met your needs and provided quality care. You can help us by rating our service by responding to the following questions.
Questions
Excellent
Good
Average
Fair
Poor
NA
1. Did nurse, therapist, and/or aide provide courteous service?
5
4
3
2
1
2. Did the staff explain the care being provided and ask your needs?
5
4
3
2
1
3. Do you feel staff members met your needs?
5
4
3
2
1
4. Did the agency provide the service and care that you expected?
5
4
3
2
1
5. Was the staff responsive to your pain and attempted to keep it at an acceptable level?
5
4
3
2
1
6. Were you told when service changed or was going to end?
5
4
3
2
1
7. Your overall rating of the agency was:
5
4
3
2
1
8. Would you recommend this agency to a friend or relative?
Yes
No
In your opinion, how can the agency improve patient safety?
Comments:
Please complete this survey so we can meet your needs in the future and if a problem exists, can correct it. We are dependent on your input
Your signature is optional.
If you do elect to complete this survey, would you allow us to call you to clarify any question?
Yes
No
Name
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Phone
Email Address
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Security Code
*