FAMILY SATISFACTION SURVEY
2010

Please answer all questions, adding any comments you'd like to make in the spaces provided.
The information on your report will be used to evaluate the quality of our 
services that your loved one receives.

Program Name or Residential Address:  (if more than one service, please list all here)

Name of Individual Served (optional):


Please choose excellent, good, fair, poor or I don't know to answer the questions below:
 
  1. Note your opinion of the program's environment (location, facility condition, furniture, etc.)  
     
   
     
  Any comments about Question #1?
 
  2. Note your satisfaction with the responsiveness of the program staff to any issues/concerns you have raised.  
     
   
     
  Any comments about Question #2?
 
  3. Note your satisfaction with the management of this program.  
     
   
     
  Any comments about Question #3?
 
  4. Note your satisfaction with staff members and how they are responding to the needs of your loved one.  
     
   
     
  Any comments about Question #4?
 
  5. Please let us know if there are any employees of Living Resources that you would like to recognize for their good/outstanding work in service to your family member.  
   

 

 

 Names:
 		 
       
  6. How would you rate the overall quality of this program?  
     
   
     
  Any comments on Question #6?
   
  7. Do you know whom to contact if you have a problem with this program? Yes     No    
           
  8. Have services improved for your family member since last year? Yes     No    
           
  9. Would you recommend this program/service to others? Yes     No    

Please give your answers to the following questions by filling in the box provided
Program #1:   (please type the name of the program your are reviewing) 
 
What do you like most about this program?

Are there any aspects of the program that need improvement?

Do you have any suggestions on ways to better communicate with families?:

 
 
Program #2:   (please type the name of the program your are reviewing) 
 
What do you like most about this program?

Are there any aspects of the program that need improvement?

Do you have any suggestions on ways to better communicate with families?:

 
 
Program #3:   (please type the name of the program your are reviewing) 
 
What do you like most about this program?

Are there any aspects of the program that need improvement?

Do you have any suggestions on ways to better communicate with families?:

 
We would appreciate receiving your most current address, phone numbers, and email address:

Name:   

Email:    
 

   Day Phone #:   

  Night Phone #:
Address:      
Fred Erlich, FErlich@LivingResources.org or call at (518)218-0000 x4317

Andrea Taichnar, ATaichnar@LivingResources.org or call at 218-0000 x 4334

Kim Darling, KDarling@LivingResources.org or call at 218-0000 x4320		  
 
 
 
 
Please share any additional comments you may have, below: