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A Medicare-Certified
Home Health Care Agency

How Are We Doing? — Customer Satisfaction Survey

Thank you for choosing Empathy Care, Inc. to provide your home health care services. As we strive to provide the highest quality, most professional service possible, we need your feedback, comments, and suggestions. Please take a few moments to complete this survey and send it back to us.

Should you need home health care at any time in the future, we would look forward to being at your service once again.

Please Check Your Choice for Each Question

1. How satisfied are/were you with the services you received?

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

Did Not Use

Nurse

4

3

2

1

0

Home Health Aide

4

3

2

1

0

Physical Therapist

4

3

2

1

0

Occupational Therapist

4

3

2

1

0

Speech Therapist

4

3

2

1

0

Social Worker

4

3

2

1

0

2. Please rate the staff who provided these services.

Strongly Agree

Agree

Strongly Disagree

Disagree

No Opinion

Was Courteous

4

3

2

1

0

Was Knowledgable

4

3

2

1

0

Professional in Appearance

4

3

2

1

0

Took Time with You

4

3

2

1

0

Answered Questions Satisfactorily

4

3

2

1

0

3. Please rate the assistance you received from the agency staff on the telephone.

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

No Opinion

Receptionist

4

3

2

1

0

Executive Director

4

3

2

1

0

Dir. of Clinical Services

4

3

2

1

0

Nursing Supervisor

4

3

2

1

0

Veranda Club (if applies)

4

3

2

1

0

Case Manager

4

3

2

1

0

* Other

4

3

2

1

0

* If Other, Who?

4. Would you use Empathy Care, Inc. again and/or recommend us to others?

Yes

No

5. Comments:

Please list services we did not offer that you would like, suggestions on how we could improve on services, or make any other comments you wish. (Box will expand to accommodate your comments.)

Completed By: (required)

Name

E-Mail Address

Thank you!

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Local Phone Calls: (561) 395-9101
Out-of-Area Calls: (800) 606-0856
The Art of Caring.
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561-395-9101

 

Staff Bios
 

Company Philosophy
 

General Services
 

Specialized Services
 

Lymphedema Therapy
 

Anodyne Therapy
 

Vestibular Rehab
 

Low Vision Rehab
 

Speech Therapy
 

Physical Therapy
 

Occupational Therapy
 

Names & Numbers
 

Client Satisfaction Survey
 

Consumer Sites
 

Home Health Compare
 

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