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* 1. Please indicate the service you received from Kaymar Rehabilitation.

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* 2. Please indicate the date range in which you received services.

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* 3. How did you hear about our survey?

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* 4. Did you receive our patient handout on privacy and safety either as hard copy or electronically?

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* 5. Please check the best response that describes your experience with Kaymar Rehabilitation.

  Strongly Agree Agree Neutral Disagree Not Applicable
Overall I was satisfied with the service I received and found it beneficial.
My safety was a priority.
I had the opportunity to ask questions and to discuss my concerns.
I was involved in planning my treatment and goals.
Goals were realistic and attainable.
I was satisfied with the amount of contact I had.
I understood and agreed with the discharge.
My request to include family or caregivers was respected.
I understood the information given and it was helpful.
I was satisfied that the therapist arrived on or close to the scheduled times.

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* 6. We appreciate your time and consideration in completing this survey. Your feedback is very important to us. Feel free to add comments in the box below. You are welcome to add the clinicians name if you would like the comments to be passed on.

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