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About Us
Our Staff
Services Offered
Memory Cafe
Therapy Dog Program
Monthly Newsletter
Monthly Calendar
Annual Activity Calendar
Satisfaction Survey
Our Board of Directors
Contact Us
SELECTION
Where did you hear about Park Place?
Friend
Doctor
Social Worker
Ad
CCCW
Telephone Book
Clergy
Another Caregiver
Other
Why did you choose Park Place?
Location
Cost
Reputation
Conventience
Hours
On recommendation
Other
STAFF
Please rate the staff in each of the following categories:
Safety attitudes
Excellent
Good
Poor
Medical Care
Excellent
Good
Poor
Skilled Staff
Excellent
Good
Poor
Appearance
Excellent
Good
Poor
Cooperation with Family
Excellent
Good
Poor
Quality of Care
Excellent
Good
Poor
Helpfulness
Excellent
Good
Poor
Friendliness
Excellent
Good
Poor
Telephone Responses
Excellent
Good
Poor
ENVIRONMENT
Is Park Place clean?
Yes
No
Is the room appearance pleasant?
Yes
No
Are the bathrooms adequate?
Yes
No
Is the neighborhood suitable?
Yes
No
Is the location convenient?
Yes
No
Do you feel safe at Park Place?
Yes
No
Is the loading zone adequate?
Yes
No
COSTS
Are you satisfied with the billing methods?
Yes
No
Are our rates reasonable?
Yes
No
Is the monthly billing clear and concise?
Yes
No
SERVICES
Would you be interested in any of the following services?
Transportation
Extended hours
Weekend hours
Physical therapy
Bathing
Shampoos
More field trips
Other (please specify)
Do you read the monthly newsletter from the director?
Always
Sometimes
Never
Do you check the monthly calendar of activities?
Always
Sometimes
Never
Do you feel that your input into the Park Place program is adequate?
Yes
No
If you answered "no" to question 4, do you have any suggestions for improved communication and/or additional involvement?
ACTIVITIES
Does your family member enjoy Park Place?
Yes
No
What does your family member like least about Park Place?
What activities, if any, would your family member like increased or added to the program?
What activities, if any, would your family member want dropped from the program?
Please feel free to add any additional suggestions or comments regarding Park Place Adult Day Services.
Thank you very much for your time and input. Please click the "Submit Form" button when you are finished.
Submit Form
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Home
About Us
Our Staff
Services Offered
Memory Cafe
Therapy Dog Program
Monthly Newsletter
Monthly Calendar
Annual Activity Calendar
Satisfaction Survey
Our Board of Directors
Contact Us
