Private Duty Patient Satisfaction Survey

A few weeks ago we were with you during your facility stay. It is important to us that we provide you with the best care and make you feel as comfortable as possible. We hope that you are feeling better and ask you to please take a moment to complete this brief survey to let us know how we did in servicing you.

Patient’s Name:
Facility Where Patient Stayed:
Service Date(s):
1. My facility offered me a packet of information about Protocall’s Private Duty Excellence Program Services.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
2. The packet was detailed and easy to read.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
3. Protocall clearly explained the billing and payment terms for service.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
4. Protocall’s office staff was polite and promptly responded to my needs or any concerns I may have had.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
5. Services were provided on the dates and shifts requested.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
6. Overall, Protocall’s caregivers were punctual.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
7. Protocall’s caregivers were caring and considerate.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
8. Protocall informed me that services could continue at home.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
9. I would recommend Protocall’s services to friends and family.	Select One Exceptional Very Good Meets Standards Improvement Needed Poor
Any additional comments or suggestions you might have for us: