Resident Family Satisfactory Survey How long have you been a resident here? Less than a year 1 -3 years 4 – 6 years 7 – 9 years Over 10 years Overall How satisfied are you with the services? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Dietary Service Dept.? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Recreation Services Dept.? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Social Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Housekeeping Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Maintenance Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Laundry Service Dept.? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Nursing Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Physician Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:How satisfied are you with the Rehabilitation Service Dept? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:Identify two positive things you have noticed during your stay with us.What do you like the most about being with us?Is there a staff member you would like to identify that has helped to make your stay better:Please Explain:Rate your overall satisfaction with the facility? Very Satisfied Somewhat Satisfied Neither satisfied nor dissatisfied Somewhat Dissatisfied Very Dissatisfied Please Explain:Would you recommend the facility to others? Yes No Please Explain:Your Name (optional) 27216
