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*  Name: *  Address: *  City/Town: *  Postcode: *  Telephone Number: *  Email: Which part of our United Care group does your nurse or care giver come from? United Home Health Care           United customized living Which most accurately describes the care you receive from us? (Please tick all that apply) Short visits (1-3 hrs) 24hr residential staff Long visits (3-6 hrs) To cover holiday/travel Day/night (6-12 hrs) Respite for usual carers Overnight stays Other (please specify) When was the last time one of our nurses visited your home? (Please select from the choices below) This week 6-12 months ago 2-4 weeks ago 12+ months 1-2 months ago Still awaiting for nurse/carer 3-5 months ago How long have you been using us to provide your care? 1-2 weeks 6-12 months 2-4 weeks 1-2 years 1-3 months 2-3 years 4-6 months 3+ years Other (please specify) How did you first find out about us? What made you decide to use us to provide your care? How would you rate the service we currently provide you, compared with when you first started using us Much Better     Little Better     No Change     A Little Worst     Much Worst     Why does the service now compare in this way? Thinking of the branch or office staff you speak with on a regular basis, how would you rate them on the following?   Very Good Good Average Poor Very Poor Staff friendliness Very Good Good Average Poor Very Poor Having a personal contact Very Good Good Average Poor Very Poor Effort to meet your needs Very Good Good Average Poor Very Poor Updating you when finding carers Very Good Good Average Poor Very Poor Informing you of new services Very Good Good Average Poor Very Poor Understanding their capabilities Very Good Good Average Poor Very Poor Requesting your feedback Very Good Good Average Poor Very Poor Being available to meet at your home, when you need them to Very Good Good Average Poor Very Poor How do you rate them overall? Very Good Good Average Poor Very Poor Being easy to contact Very Good Good Average Poor Very Poor Confirming which staff will be working with you Very Good Good Average Poor Very Poor How often does you branch visit or call you to make sure everything is running smoothly? Every day     Once a week     Every fortnight     Every Month     Never     How often does you branch visit or call you to make sure everything is running smoothly? Every day     Once a week     Every fortnight     Every Month Never (If so, Why?) Is there anything we can do to improve the service we provide? How would you rate the workers we provide, on the following?   Very Good Good Average Poor Very Poor Arriving on time Very Good Good Average Poor Very Poor Being caring and supportive Very Good Good Average Poor Very Poor Being well presented Very Good Good Average Poor Very Poor Being polite and respectful Very Good Good Average Poor Very Poor Having the right skills and training Very Good Good Average Poor Very Poor Working on their own initiative Very Good Good Average Poor Very Poor Providing all the care you need Very Good Good Average Poor Very Poor Having enough time for you Very Good Good Average Poor Very Poor Wearing an identification badge Very Good Good Average Poor Very Poor How do you rate our staff overall? Very Good Good Average Poor Very Poor Is there anything we can do to improve the quality of the workers we provide you? Have you ever had a problem or complaint that you have contacted the agency about? Yes, a problem Yes, a complaint     Yes, both     No Have you ever used our on-call service? Yes       No When did you last use our on-call service? How would you rate the workers we provide, on the following?   Very Good Good Average Poor Very Poor Someone being available Very Good Good Average Poor Very Poor The friendliness of on-call staff answering your call Very Good Good Average Poor Very Poor Helping you with your problem Very Good Good Average Poor Very Poor Time taken to answer your call Very Good Good Average Poor Very Poor Taking / passing on messages Very Good Good Average Poor Very Poor Overall, how do you rate our on-call service? Very Good Good Average Poor Very Poor Is there anything we can do to improve our on-call service? How likely would you be to recommend United Care Group, Inc Definitely would Quite unlikely Very likely Would not recommend Quite likely What could we do to make you more likely to recommend us to people? How much do you agree or disagree with the following statements?   "All things being equal, I would prefer to use United Care Group, Inc. above any other agency" Strongly agree    Agree    Neutral    Disagree    Strongly Disagree   "I only use other agencies if United care Group, Inc can't help me" Strongly agree    Agree    Neutral    Disagree    Strongly Disagree If there was one change that we could make to encourage you to work with us more, what would it be? Do you have any further comments and thoughts on United care Group, Inc? Thank you for completing our Private Client Satisfaction Survey