Quality Care Survey

Blossom Ridge Home Health & Hospice

Question Title

* 1. My Nurse provided me with excellent care.

Yes

No

N/A

Comments:

Question Title

* 2. My Physical Therapist, Occupational Therapist and/or Speech Therapist provided me with excellent care.

Yes

No

N/A

Comments:

Question Title

* 3. How often did Blossom Ridge providers seem informed and up-to-date about the care you received?

Sometimes

Usually

Always

Comments:

Question Title

* 4. How often did Blossom Ridge providers treat you with courtesy, respect and listen carefully to you?

Sometimes

Usually

Always

Comments:

Question Title

* 5. How often did Blossom Ridge keep you informed about when they would arrive at your home?

Sometimes

Usually

Always

Comments:

Question Title

* 6. What number would you use to rate your care from Blossom Ridge? Blossom Ridge’s goal is 9 or higher. If we didn’t accomplish this what could we have done better?

8 or less

9

10

Comments:

Question Title

* 7. Would you recommend Blossom Ridge to your family or friends if they need home health care? Blossom Ridge’s goal is “definitely yes”. If we didn’t accomplish this what could we have done better?

Probably Yes

Definitely Yes

Comments:

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* 8. Additional Comments:

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* 9. Optional - Please enter the name or names of your Nurses, Therapist, Social Worker, and Home Health Aide:

Question Title

* 10. Optional - Contact Information

Name

Patient Name

Email Address

Phone Number