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* 1. Last Name, First Name (optional):
If you are not the patient, please write your relationship to the patient.

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* 2. Date

Date

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* 3. Select the level of care provided?

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* 4. On an overall basis, was the service of Complete Home Care Services satisfactory? Was our staff courteous, polite and informative?  Select the rating that best describes your response.

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* 5. Were sufficient instructions given to you to ensure safe care?  Did the caregiver show concern for your safety?

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* 6. Did your caregiver wash their hands?

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* 7. Did staff provide you with a 24 hour On Call number?

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* 8. Was our staff helpful (Office Personnel)?  Select the rating that best describes your response.

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* 9. Were your billing inquires handled to your satisfaction?  If no, please explain.

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* 10. Do you have any recommendations to improve our service?
If you do not consent to publicly posting your comments on this survey - please write "Do not post comments."

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