Customer Satisfaction Survey (Caregiver Training)

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This survey will only take 5 minutes to complete.

Care Recipient's Name

Your Name

Date of Training

date_range

Trainer

Select An OptionJosephine PohNangBarclay

Overall, how much would you rate your experience with RasaCare?

1 - Poor2 - Fair3 - Good4 - Excellent

How much do you agree with the following statements?

 4 = Strong Agree, 3 = Agree, 2 = Disagree, 1 = Strong Disagree

EnquiringFill in where applicable

	Did not rate	4	3	2	1
It was easy for me to obtain information I needed through RasaCare’s website.

Service Activation

	Did not rate	4	3	2	1
The staff promptly attended to all my inquiries.
The staff I corresponded/spoke with was friendly and polite.
The staff was informative and attentive.
It was easy for me to book a training session with RasaCare.
The staff was helpful in assisting me through the form filling process.
Overall, I am satisfied with the service of the office staff.

Caregiver Training

	Did not rate	4	3	2	1
The trainer was clear in his/her presentation.
The trainer was respectful and approachable; I felt comfortable talking to the trainer.
The trainer was sensitive to the needs of my loved one and the caregiver, and gave appropriate and helpful advice.
Overall, I am satisfied with the service provided by the trainer.

On a scale of 1 to 5...

	1	2	3	4	5	Did not rate
How likely are you to engage RasaCare again if required?
How likely would you recommend RasaCare to someone else?

What was done particularly well during the home visit by the trainer?

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What are some areas for improvements?Especially if you indicated 'disagree' or 'strongly disagree' on any of the above fields.

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Do you wish to compliment any nurse and/or staff?"Thank you!"

0 /

Thank you for your valuable feedback!

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