SUPPORTING CHILDREN AND FAMILIES TO LIVE LIFE TO ITS FULLEST
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Evaluate your experience
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Text
What service did you experience?
Clinical
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I am…
Option 1
Clinical – We were satisfied with the care provided by the hospice staff?
1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
5 No opinion
Our concerns were dealt with in a timely manner
1 Strongly agree
Option 1
We would recommend the hospice to those who may need their service
1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
5 No opinion
Clinical – We were satisfied with the care provided by the hospice staff?
1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
5 No opinion
Any other comments
Our concerns were dealt with in a timely manner
1 Strongly agree
2 Agree
3 Disagree
4 Strongly disagree
5 No opinion
If you are human, leave this field blank.
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