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Patient Satisfaction Survey
  1. Were you treated with respect and dignity by the Nurse?
  2. ... by the Home Health Aide?
  3. ... by the Physical Therapist?
  4. ... by the Occupational Therapist?
  5. ... by the Speech Therapist?
  6. ... by the Medical Social Worker?
  7. Were your needs met?
  8. Were you included in your care?
  9. Were the procedures explained to your?
  10. Do you know how to voice a complaint?
  11. Do you understand agency charges, what is covered by your insurance?
  12. Do you understand your rights?
  13. Would you recommend oru services to friends and family?
  14. Comments & Suggestions
  15. Survey Completed by
  16. Relationship
  17. Patient Name
  18. Phone
  19. Security