GoldenHandsHomeCare

Resolving dependencies...

New member survey

Member Name:

The following questionnaire survey measures the satisfaction of services provided by Golden Hands Home Care, Inc to members. Please complete this survey with your level of satisfaction with our Agency.

Verbal Answer Code Index

A= Excellent B= Good C= Average D= Under acceptable

S/N	Questionnaire	A	B	C	D
1	How would you rate the service you received from our employee of Golden Hands Home Care, Inc?	Excellent	Good	Average	Under acceptable
2	How would you rate Golden Hands Home Care, Inc employee based on their job knowledge and skills?	Excellent	Good	Average	Under acceptable
3	How would you rate the Golden Hands Home Care, Inc employee's attitude and honesty?	Excellent	Good	Average	Under acceptable
4	What is your satisfaction level with Direct Care Worker Services?	Excellent	Good	Average	Under acceptable
5	How polite and honest is Direct Care Worker on you?	Excellent	Good	Average	Under acceptable
6	How is the companionship of Direct Care Worker on you?	Excellent	Good	Average	Under acceptable

Agency Representative/Print Name:

Position:

Signature:

Date:

Back