July 14, 2021 debby Client Satisfaction Survey Client Satisfaction Survey Client Name or Initial Contact Information ( Optional) Please fill out our brief Customer Satisfaction Survey. All of us at Choice Community Health would like to thank you for using our services. We welcome your feedback regarding the care that you receive from us. Your honesty helps us work toward better service for everyone, while ensuring customer satisfaction. How long have you used our agency for services? Less than a month 1-12 months 1-3 years 3-5 years More than 5 years Which services do/did you receive? ACT PRP Residential Treatment Service OTX Home Health Aide Services Skilled Nursing Services Physical Therapy Services How satisfied are you with your involvement with decision making regarding the plan of care ? Satisfied Extremely Satisfied Somewhat Satisfied Not Satisfied Extremely Dissatisfied Did our staff explain your rights and responsibilities as a patient?. Strongly Agree Agree N/A Disagree Strongly Disagree I feel the staff members were competent and had the skills necessary to care for me. Strongly Agree Agree N/A Disagree Strongly Disagree My Privacy and Property is respected Strongly Agree Agree N/A Disagree Strongly Disagree I am satisfied with the on-call services that are available after hours. Strongly Agree Agree N/A Disagree Strongly Disagree I am satisfied with Choice Community Health Management. Strongly Agree Agree N/A Disagree Strongly Disagree Overall, how would you rate Choice Communication Health compared to our competitors? Much Better Somewhat Better Same Somewhat Worse Much Worse How satisfied are you with our services overall? Extremely Satisfied Quite Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Quite Dissatisfied Extremely Dissatisfied I would recommend Choice Community Health to friends and/or family. Strongly agree Agree N/A Disagree Strongly disagree Additional suggestions you would like to share with us: