Tell us how we are doing! Name: Date of Birth: Date of Stay: Food Ratings 1 2 3 4 5 Please check the box that best fits your experience. 1 being the poorest quality and 5 being excellent quality.Activities Ratings 1 2 3 4 5 1 being the worst experience and 5 being the best experience.Staff Courtesy Ratings 1 2 3 4 5 1 being the worst experience and 5 being the best experience.Nursing Care RatingI did not have to wait too long for my call light to be responded to? Yes No Therapy met my expectations? Yes No Customer Service RatingThe admission paper work was explained clearly to me and/or my family. Yes No I was included in the plan for my discharge arrangements? Yes No Cleanliness RatingMy room is cleaned daily. Yes No Additional QuestionsI would return to this facility if I required skilled nursing services again. Yes No I would recommend this facility to others. Yes No Your additional comments are appreciated.CAPTCHA Δ
