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Employee Information
First Name:
*
Last Name:
*
Email:
*
Guest Information
First Name:
*
Last Name:
*
Email:
Mobile/Phone:
Location:
*
Please select a location...
Barnwell
Batavia
Chestnut Park
Chittenango
Colonial Park
Delaware Park
Great Neck
Guilderland
Mayfair
Mohawk Valley
Pawling
Queens
River Valley
Robinson Pavilion
Robinson Terrace (SNF)
Rochester
Rome
South Point
Utica
Relationship to Resident:
*
Self
Spouse
Parent
Child
Do you have any comments, questions, or concerns?
Questions
(1 - very unsatisfied , 2 - unsatisfied, 3 - neutral, 4 - satisfied, 5 - very satisfied )
1. Is the facility clean?
Yes
No
2. What hospital were you referred from?
3. I felt welcomed by the staff when I first arrived.
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3
4
5
4. Overall, I am satisfied with the admission process from the hospital.
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5
5. The staff was able to assist me with any questions or concerns that I had.
1
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3
4
5
6. I was satisfied with the medical care at The Grand Rehabilitation and Nursing at (facility).
1
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3
4
5
7. I found my therapy sessions to be valuable.
1
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3
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5
8. Overall, the activity programs offered met my needs.
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5
9. My social worker followed up and responded quickly to my concerns.
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5
10. The meals offered were enjoyable, tasty, and satisfying.
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5
11. My laundry was cleaned and returned to my room in a timely manner.
1
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4
5
N/A
12. My room was clean, free of odors, and presentable.
1
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4
5
13. As a whole, I was satisfied with the services offered at The Grand Rehabilitation and Nursing at (facility).
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5
14. I would recommend The Grand Rehabilitation and Nursing at (facility) to a family member and/or friend.
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2
3
4
5
