Welcome to the Texas Health and Human Services Commission > Regulatory Services > Waiver Survey and Certification provider feedback survey.

Please take a few moments to let us know about the recent HHSC (Formerly DADS) Regulatory visit to your facility.

If you have questions, concerns, or compliments about the visit and would like to speak to someone directly, please call:
1-800-458-9858(Voice)
1-888-425-6889 (TDD)

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* Demographic Information

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* In what  type of survey did you participate?

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* Date of survey

Date

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* Survey Feedback

  Always Often Sometimes Never
We understand the issues for which we were cited:
The survey team explained the Principles that resulted in citations:
We found the survey to be a positive learning experience:
We found the Survey team to be knowledgeable, professional, and helpful:
We can apply the information we learned in the survey process to our program:

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* Professionalism and Courtesy

  Always Often Sometimes Never
The conduct of the surveyor(s) during the visit was professional and courteous to staff.
The conduct of the surveyor(s) during the visit was professional and courteous to residents / consumers.
The surveyor(s) applied standard survey procedures during the visit.
The surveyor(s) considered all pertinent evidence.
The surveyor(s) kept you informed of the progress of the survey during the course of the survey.
The surveyor(s) considered all evidence presented to refute citations/violations prior to exit.

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* Additional comments:

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