Resident Family Satisfactory SurveyHow long have you been a resident here?Less than a year1 -3 years4 – 6 years7 – 9 yearsOver 10 yearsOverall How satisfied are you with the services?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Dietary Service Dept.?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Recreation Services Dept.?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Social Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Housekeeping Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Maintenance Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Laundry Service Dept.?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Nursing Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Physician Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:How satisfied are you with the Rehabilitation Service Dept?Very SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease 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 SatisfiedSomewhat SatisfiedNeither satisfied nor dissatisfiedSomewhat DissatisfiedVery DissatisfiedPlease Explain:Would you recommend the facility to others?YesNoPlease Explain:Your Name (optional)
