Client Satisfaction Survey

Let us know how we did!

Fill out the form below to give us important feedback on how we’re doing. You can also leave us a Google review.

Please fill out our brief Customer Satisfaction Survey. All of us at Hiawatha HomeCare would like to thank you for using our services. We welcome your feedback regarding the care that you receive from us. Your honesty helps us work toward better service for everyone, while ensuring customer satisfaction.
How long have you used our agency for nursing/skilled services?*
- Less than a month
- 1-12 months
- 1-3 years
- 3-5 years
- More than 5 years
Which services do/did you receive?*
- Complex RN/LPN Services
- Skilled Nursing Services
- Physical Therapy Services
- Home Health Aide Services
- Homemaker Services
- Other
How often do/did you receive our services?*
- 8-10 hours per day
- 12-16 hours per day
- 17-24 hours per day
- Skilled visits 1-7 days per week
- Other
I am satisfied with the level of customer service I receive from Hiawatha HomeCare.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
I am satisfied with the quality of skilled services I received.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
I feel the staff members were competent and had the skills necessary to care for me.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
I am satisfied with Hiawatha HomeCare's Staffing/Scheduling Department.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
I am satisfied with the on-call services that are available after hours.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
I am satisfied with Hiawatha HomeCare's Administration Department.*
- Strongly Agree
- Agree
- No Opinion
- Disagree
- Strongly Disagree
Overall, how would you rate Hiawatha HomeCare's services compared to our competitors?*
- Much Better
- Somewhat Better
- Same
- Somewhat Worse
- Much Worse
- No Opinion
How satisfied are you with our services overall?*
- Extremely Satisfied
- Quite Satisfied
- Somewhat Satisfied
- Neutral
- Somewhat Dissatisfied
- Quite Dissatisfied
- Extremely Dissatisfied
I would recommend Hiawatha HomeCare's services to friends and/or family.*
- Strongly agree
- Agree
- No Opinion
- Disagree
- Strongly disagree
What impressed you most about our services?*
What disappointed you most about our services?*
Additional suggestions you would like to share...
OPTIONAL: Name
First Last
OPTIONAL: Email
Date
MM slash DD slash YYYY

4920 Moundview Drive, Suite B
Red Wing, MN 55066

800-837-8898
info@hiawathahomecare.com

Facebook Instagram

Explore Hiawatha

Main Menu

Private Duty Nursing
Skilled Nursing Visits
Non-Medical Home Services
About Hiawatha
Careers

Resources

Main Menu

FAQ
Healthcare Resources
HIPPA
Privacy Policy

Staff Login

Pay Now

|

Web Design By Sievers Creative