PHC/FC/CAS Client Satisfaction Survey
You have recently received services from AmeriTouch Home Health Services INC. We want to ensure that we continue to provide quality care. You can help us improve our services by rating our service by responding to the following questions. Please return this form to our agency.
Rating Questions
1. Did the Caregiver provide warm, courteous and friendly services?
2. Did the Caregiver meet your needs?
3. Did the Agency inform you if they were going to be late?
4. Did the agency provide the service that you expected?
5. Did office personnel respond promptly to your calls?
6. You overall rating of the agency was.
Excellent
Good
Average
Fair
Poor
Would you refer a friend or family member to our agency? If No, please indicate reason.
Comments:
Signature (Optional):
Date:
Please return this form to the agency. Your signature is optional. May we contact you regarding your response to this survey
Thank you for completing this form.
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