PAS CLIENT SATISFATION SURVEY AmeriTouch Home Health Services Inc PAS Client Satisfaction Survey PAS CLIENT SATISFACTION SURVEY You have recently received services from AmeriTouch Home Health Services Inc. We want to insure that we continue to provide quality care. You can help us improve our service by rating our service by responding to the following questions Section Buttons Thank you for completing this form Name Email 1. Did the Caregiver provide warm, courteous and friendly service? * Excellent Good Average Fair Poor 2. Did the Caregiver meet your needs? * Excellent Good Average Poor Fair 3. Did the Agency inform you if they were going to be late? * Excellent Good Average Fair Poor 4. Did the Agency provide the service that you expected? * Excellent Good Average Fair Poor 5. Did office personnel respond promptly to your calls? * Excellent Good Average Fair Poor 6. Your overall rating of the Agency was? * Excellent Good Average Fair Poor 4. How likely is it that you would recommend this agency to a friend or colleague? * 1 2 3 4 5 6 7 8 9 10 0 is not at all likely, 10 is extremely likely 5. Do you have any other comments, questions, or concerns? May we contact you regarding your response to this survey? YESNO Section Buttons SUBMIT RESPONSE