Nursing Facility/Assisted Living/Personal Care Home Satisfaction Survey



  • Facility:

  • Discipline of person completing survey:

  • If other, please specify:

  • 1. Did you feel that the Valley Hospice staff was professional?:

  • 2. Do you feel that the employees in your facility have an understanding of hospice care?:

  • If no, would you like to set up an in-service for your staff?:

  • 3. Were Valley Hospice staff members invited to attend the care plan meetings?:

  • 4. Were you satisfied with communication/interaction with Valley Hospice staff? (specific disciplines listed below):

  • RN:

  • CNA:

  • MD:

  • Social Worker:

  • Chaplain:

  • If no, please elaborate:

  • 5. If you contacted the Valley Hospice primary or on-call RN, did he/she respond in a timely fashion?:

  • Additional Comments:

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