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Homeward Bound Consumer Satisfaction Survey
*
1.
I am satisfied with the residence and the physical living environment.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
2.
I am confident that appropriate care, treatment, and safety are being provided.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
3.
I am satisfied with the training of direct care staff.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
4.
I am satisfied with the training of nursing staff.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
5.
I am satisfied with supervisor of the house.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
6.
HBI responds to my questions and concerns in a timely manner.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
7.
I know the appropriate house level leadership to contact for the person I represent.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
8.
I can approach HBI's corporate management with any questions or concerns.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
9.
I am treated with respect by HBI staff members.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
*
10.
I feel the person I represent has the opportunity to participate in activities they enjoy.
(Required.)
Strongly Disagree
1 star
Disagree
2 stars
Neutral
3 stars
Agree
4 stars
Strongly Agree
5 stars
Not Applicable
Comments:
11.
Homeward Bound can improve services by:
*
12.
Select the service site your are responding about.
(Required.)
36th
43rd
82nd
92nd
Althea
Atwood
Bluebird
Fountain Lane
Independence
Jersey
June
Lake Drive
Lee
Maple Grove
Medicine Lake
Noble Court
Plymouth
Saratoga
Sugarloaf
Webster
Winnetka
Zealand
*
13.
Please identify your role.
(Required.)
Guardian
Case Manager
Individual Served
14.
Name (Optional)