Satisfaction Survey

Indicate one of the following categories for which you are providing feedback:
---Affinity Hospice Foundation DonorPatient/Caregiver Student InternTraining Class ParticipantVolunteerWebsite Browser

How did you hear about Affinity Home Hospice?
---InternetYellow PagesWord of MouthOther

How often have you visited our website?
---Less than 5 times5-10 timesMore than 10 times

Did you find the information you were looking for?
---YesNo

Did you find the website to be easy to navigate?
---YesNo

Overall, how would you rate your experience with Affinity?
---Very GoodGoodFairPoorVery Poor

For Donors:

Have you previously contributed to Affinity Hospice Charity Foundation?
---YesNo

Do you prefer to donate online or via the mail?
---OnlineMail

Did you find the online donation process to be easy?
---YesNoNot Applicable

Was your contribution acknowledged in a timely manner?
---YesNo

For Patients/Caregivers:

Please rate the following team member on a scale of 0 (very poor) to 5 (best) in regards of patient care received:

Registered Nurse:
---012345No opinionNot utilized

Home Care Aide:
---012345No opinionNot utilized

Social Worker Services:
---012345No opinionNot utilized

Chaplain Services:
---012345No opinionNot utilized

Volunteer Services:
---012345No opinionNot utilized

Overall Rating:
---012345No opinionNot utilized

Do you feel that services provided to the patient/family are what you expected since the day of admission?
---YesNo

Is the hospice team member calling before their arrival?
---YesNo

Have you utilized calling after hours?
---YesNo

If you have not utilized calling after hours, do you know the number to call?
---YesNo

If you have utilized calling after hours, was the response timely and did the nurse on-call resolve the problem?
---YesNo

Are there any suggestions that you may have for us to improve our services to you and your family?
---YesNo

If "Yes", please explain below:

For Training Class Participants:

Did you enjoy the training?
---YesNo

Did you feel that the training was well planned?
---YesNo

Was the trainer knowledgeable of the material presented?
---YesNo

Would you attend another training presented by Affinity?
---YesNo

For Volunteers / Students:

Did you enjoy your placement with Affinity?
---YesNo

Were the staff members helpful?
---YesNo

Would you recommend Affinity to a friend for volunteering or student field study?
---YesNo

Were your expectations met through your experience with Affinity?
---YesNo

Please click on the "Send" button below to send your responses to Affinity.