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1. Age

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2. Gender

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3. Race

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4. How long have you been receiving homemaking services?

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5. The caregivers arrive on time and adhere to the scheduled visits.

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6. The caregivers communicate clearly and respectfully.

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7. How would you rate the professionalism and friendliness of the caregivers?

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8. The care plan provided meets my needs and expectations.

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9. Overall, how satisfied are you with the quality of the homecare services?

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10. Do you have any concerns with the homecare services?

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11. Additional Comments

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