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1. Please identify from which NOSH site you accessed a community program (Required.)

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2. Please indicate which community service you will be providing feedback on (Required.)

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3. Overall, how wold you rate the care and services you received? (Required.)

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4. Would you recommend this program to others? (Required.)

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5. How often do you feel staff treat you with dignity and respect? (Required.)

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6. Do you feel you have enough say in planning your care? (Required.)

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7. How often does staff listen carefully to you? (Required.)

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8. Did staff help you to access other services and supports available? (Required.)

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9. How would you rate the overall quality of the food? (Required.)

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10. What more can we do to improve the quality of care you have received?

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