Client Satisfaction Survey

Question Title

* 1. What house are you providing feedback for?

Question Title

* 2. Are you answering this survey as the resident or on behalf of someone in our care?

Myself - I'm a resident

Family Member in your care

Other

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* 3. How are medical services being paid?

Privately

Medicaid (CADI or BI)

Medicaid (EW)

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* 4. How long has it been since you or your loved one was admitted to our home?

Less than a week

1 - 4 weeks

1 - 6 months

6 months - 1 year

1 - 2 years

Greater than 2 years