Nursing Home Feedback Form
Nursing Home Feedback Form
Please complete this feedback form to help us understand your satisfaction with our services and identify areas for improvement. Rate each item using the standard rating scale provided: 1 (Very Unsatisfied) - 5 (Very Satisfied).
|
1 |
2 |
3 |
4 |
5 |
|
|
I. Overall Experience |
|||||
|
A. Satisfaction with the overall care received |
|
|
|
|
|
|
B. Comfort and cleanliness of the facility |
|
|
|
|
|
|
II. Resident Care |
|||||
|
A. Quality of medical care |
|
|
|
|
|
|
B. Responsiveness to residents' needs and requests |
|
|
|
|
|
|
C. Respect and dignity shown towards residents |
|
|
|
|
|
|
III. Staff |
|||||
|
A. Professionalism and friendliness of staff |
|
|
|
|
|
|
B. Staff availability and accessibility |
|
|
|
|
|
|
C. Communication effectiveness of staff |
|
|
|
|
|
|
IV. Amenities and Activities |
|||||
|
A. Quality and variety of food services |
|
|
|
|
|
|
B. Availability and variety of activities and programs |
|
|
|
|
|
|
C. Accessibility and comfort of common areas |
|
|
|
|
|
|
V. Family and Visitor Experience |
|||||
|
A. Ease of visiting and interacting with residents |
|
|
|
|
|
|
B. Communication and information provided to families |
|
|
|
|
|
|
C. Overall satisfaction with the visitor experience |
|
|
|
|
|
Suggestions for Improvement
We value your feedback as it is crucial in our continuous effort to improve our services and ensure the highest level of care and satisfaction for our residents and their families. Thank you for taking the time to share your thoughts and experiences with us.
