Consumer Satisfaction Survey

Thank you for allowing us to provide services for you or your family member. We are interested in ideas or opinions about our services. Please take a moment to answer the following questions. If you need assistance in completing this form, please feel free to contact our office, at (724) 652-5144.

I am satisfied with the services provided by the Independent Living Coordinator(s).
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

I am satisfied with the services provided by the Attendant(s).
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

DON SERVICES staff explained the services and care to be provided as well as the expected outcomes.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

I have been involved in the decision-making process regarding my homecare plan from the initial home assessment until now.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

I am receiving the type of services needed to maintain my independence.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

The staff generally arrives as scheduled.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

My health, safety, and privacy are adequately protected.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

When I called the DON Services agency, office staff was courteous and available, and directed my call correctly.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

I will continue to use DON Services care in my home.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

I would recommend DON Services to friends and relatives.
Strongly AgreeAgreeDisagreeStrongly DisagreeNo Opinion or Not Applicable

Suggestions for improvement/additional comments:

What most impressed me about the care/services provided by DON Services agency was:

I would/would not like to discuss my responses further
WouldWould not

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