www.royalrehab.com.au
1. Adult & Aged Care Rehab Services (CARS/Dixson, Coorabel Unit) - Client Survey
1
. Client Survey Code (Internal Use Only)
Client Survey Code (Internal Use Only)
2
. Date
DD
MM
YYYY
Please enter date in format shown.
Date Please enter date in format shown. Day
/
Month
/
Year
3
. Person/s completing survey:
Person/s completing survey:
Self
Self with assistance
Family or significant other
Carer
Other, please specify:
4
. Client gender
Client gender
Male
Female
5
. Client age group
Client age group
15-29
30-49
50-69
70-89
90+
6
. Health condition that lead to contact with Royal Rehabilitation Centre (Royal Rehab):
Health condition that lead to contact with Royal Rehabilitation Centre (Royal Rehab):
Brain Injury
Spinal Injury
Stroke
Orthopaedic condition
Other, please specify:
7
. Services used (Please tick all that apply):
If you have recently used more than one service, please only fill in this survey in relation to the Adult or Aged Care Rehabilitation Service (CARS/Coorabel/Dixson Units). For other services that you have used, for which you would like to provide feedback, please contact the Centre via phone: 02 9807 1144, or email: feedback@royalrehab.com.au and the appropriate survey will be forwarded to you.
Services used (Please tick all that apply): If you have recently used more than one service, please only fill in this survey in relation to the Adult or Aged Care Rehabilitation Service (CARS/Coorabel/Dixson Units). For other services that you have used, for which you would like to provide feedback, please contact the Centre via phone: 02 9807 1144, or email: feedback@royalrehab.com.au and the appropriate survey will be forwarded to you.
Adult Rehabilitation Services (Coorabel/CARS Unit)
Aged Care Rehabilitation Unit (Dixson)
Spinal Injury Unit (Moorong)
Brain Injury Unit
Brain Injury Community Rehabilitation Team (BICRT)
Outpatients Department
Driving Assessment Centre
Extended Care Services - Weemala Service
Community Accommodation and Support Service (Group Homes)
Neurobehavioural Rehabilitation Service
Home Based Rehabilitation Service
33%
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