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Entry Survey

Employee Information




Guest Information




Do you have any comments, questions, or concerns?

Any comments can be used for marketing purposes

Questions

(1 - very unsatisfied , 2 - unsatisfied, 3 - neutral, 4 - satisfied, 5 - very satisfied )

1. Did you feel welcomed by the staff members?

2. Do all staff treat you with courtesy and respect?

3. Does the nursing staff listen carefully to you and explain things to you?

4. Is the area around your room quiet at night?

5. Do you feel you are on task with your therapy sessions?

6. Do you have any favorite activities?

7. Would you be interested in going to the activities that we offer here?

8. Who is doing your laundry?

9. Was your clothing labeled?

10. Is your room clean, free of odor, and presentable?

11. Are the meals enjoyable, tasty, and satisfying?

12. Are you satisfied with the appearance and temperature of your food when it arrives?

13. Would you like to try the Grandwich of the week or choose from the "always available list"?

14. Is there anything we can do to make your stay here more comfortable?