Elder Care Choices Quality Assessment Survey

1.    Was the counselor you talked with helpful, polite and knowledgeable?

            Definitely                                                                     Not at all

5        4         3        2        1   

2.     Did the counselor provide appropriate information and the assistance that you needed?

                    Definitely                                                                            Not at all

          5         4         3         2         1

3.     If you received educational materials  from Elder Care Choices, did you find them helpful.?

                    Definitely                                                                            Not at all

          5         4         3         2         1

4.     Did you actually choose a service, program, or facility from the referrals sent you ?

          Yes No

5.     If yes, are you satisfied with the care chosen ?

          Yes No

If no, please indicate why you did not choose among those options.

Please click the number that best describes how helpful the services had been in terms of your job performance.  The help from Elder Care Choices:

6. Reduced need to arrive late, leave early,  or take time off for dependent care ?

                     Definitely                                                                         Not at all

          5           4         3       2         1

7. Reduced amount of time spent on phone with caregiving concerns ?

                        Definitely                                                                             Not at all

         5         4         3         2         1

8.     If you had a need in the future, would you use Elder Care Choices again ?

        Yes     No

9     Would you recommend Elder Care Choices to fellow employees ?

         Yes     No

Please add any further comments here,

Thank you for your time.