Community Advantage Client Survey

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* 1. The services received were for:

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* 2. The services received were:

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* 3. Please enter your therapist's name below:

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* 4. Please provide your name (optional):

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* 5. Client Centered - Select the appropriate rating which best describes how you feel about the following statements:

  Strongly Agree Somewhat Agree Neither Disagree or Agree Somewhat Disagree Strongly Disagree
The therapist listened to me and involved me in developing the plan to address my needs.
I was provided with appropriate information and easy to understand instructions, as needed.
The therapist's visits were arranged at a convenient time.
The therapist was on time for my visits.
I was kept informed of when the therapist would arrive.

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* 6. Quality - Select the appropriate rating which best describes how you feel about the following statements:

  Strongly Agree Somewhat Agree Neither Disagree or Agree Somewhat Disagree Strongly Disagree
I feel the services I received were helpful.
I was happy with the quality of services provided by the therapist.

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* 7. The therapist spoke to me about my safety in my home.  Some examples may be discussing falls risk or community supports such as Lifeline, completing a cognitive assessment, recommending equipment for the home (shower chairs, grab bars) and  addressing mobility issues .

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* 8. After no longer receiving services from the CAR Service Provider, I am still able to manage my activities safely at home.

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* 9. Since the time the services with the CAR Service Provider ended, the number of falls I have had are: 

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* 10. Since the time my services with the CAR Service Provider ended, the number of emergency department visits or hospital readmissions I have had are:

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* 11. If you have any comments you would like to make or new concerns you would like to have addressed by one of our Service Providers, please list them below and we will gladly give you a call to discuss.  If your telephone number has changed since receiving our services, please provide the new number.  If you are leaving a comment about equipment, please contact your Care Coordinator at the LHIN.

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* 12. How likely is it that you would recommend Community Advantage Rehabilitation to a friend or colleague?

Not at all likely
Extremely likely
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