Free Nursing Home Resident Satisfaction Survey Template
Nursing Home Resident Satisfaction Survey
Kindly evaluate each statement using a scale from one to five, where one indicates that you are very dissatisfied, and five signifies that you are very satisfied.
Name
Phone number
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Quality of Care |
5 |
4 |
3 |
2 |
1 |
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How satisfied are you with the medical care provided by the nursing home |
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How would you rate the attentiveness and responsiveness of the nursing staff? |
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How well do you feel your personal care needs are met (e.g., bathing, dressing)? |
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Staff Interaction |
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How respectful and courteous are the staff members? |
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How effectively does the staff communicate with you? |
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How satisfied are you with the level of support provided by the staff? |
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Facility Environment |
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How clean and well-maintained is your living area? |
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How comfortable and safe do you feel in the facility? |
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How would you rate the overall condition of common areas (e.g., lounges, dining areas)? |
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Food and Dining |
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How satisfied are you with the quality of the food provided? |
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How would you rate the variety and nutritional value of the meals? |
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How responsive is the dining service to special dietary needs or preferences? |
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Activities and Engagement |
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How satisfied are you with the recreational activities offered? |
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How engaged do you feel with the social and cultural programs available? |
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How would you rate the availability and quality of activities tailored to your interests? |
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Overall Satisfaction |
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Overall, how satisfied are you with your experience at the nursing home? |
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What do you like most about living in the facility? |
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What areas do you think need improvement? |
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Additional Comments
Please provide any additional feedback or suggestions for improvement.
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