Satisfaction Survey

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caring for you at Park Place Adult Day Services

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.
Should be Empty:

Home
About Us
Our Staff
Services Offered
Memory Cafe
Therapy Dog Program
Monthly Newsletter
Monthly Calendar
Our Board of Directors
Contact Us

​caring for you at Park Place Adult Day Services

SELECTION

STAFF

ENVIRONMENT

COSTS

SERVICES

ACTIVITIES

Thank you very much for your time and input. Please click the "Submit Form" button when you are finished.

caring for you at Park Place Adult Day Services