* Required Information
Please select the services you received or are receiving:
Skilled Nursing
Personal Care services
Home Health Aide Services
My aide/nurse/ is responsive to my needs:
Strongly Agree
Agree
Disagree
Strongly Disagree
My aide/nurse/ listens when I talk:
Strongly Agree
Agree
Disagree
Strongly Disagree
My privacy/property is respected:
Strongly Agree
Agree
Disagree
Strongly Disagree
Did our staff explain your rights and responsibilities as a patient/family member?
Strongly Agree
Agree
Disagree
Strongly Disagree
Was the patient and/or the family involved in the decision making regarding the plan of care?
Strongly Agree
Agree
Disagree
Strongly Disagree
My aide/nurse/ makes their scheduled visits/shifts:
Strongly Agree
Agree
Disagree
Strongly Disagree
Did your nurse, or aide introduced him/herself and explain the plan of care, allowing you and/or your caregiver to ask questions?
Strongly Agree
Agree
Disagree
Strongly Disagree
Did our staff give instructions and information in terms you could understand?
Strongly Agree
Agree
Disagree
Strongly Disagree
I am informed of any visit/shift changes:
Strongly Agree
Agree
Disagree
Strongly Disagree
I know how to contact the office if I have a problem or complaint:
Strongly Agree
Agree
Disagree
Strongly Disagree
When I call the office, the staff is courteous and helpful:
Strongly Agree
Agree
Disagree
Strongly Disagree
Overall, I am satisfied with the services provided by Infinicare Inc:
Strongly Agree
Agree
Disagree
Strongly Disagree
I would recommend Infinicare Inc. to a family member or friend:
Strongly Agree
Agree
Disagree
Strongly Disagree
Comments/Suggestions for Improvement
Who is or was your attendant/aide/nurse? (Please write their name here):