Auburn Crest - Survey Form

Thank you for allowing Auburn Crest Hospice (ACH) to provide hospice services to someone dear to you. We constantly strive to improve the services we provide, and our patients and clients are the best source of information to help us in this process.

Below are several questions about our recent hospice care efforts. Please answer each question by marking the box that best indicates your opinion, or if a question doesn't apply to your situation, mark "NA.". Your answers always help us improve our delivery of services. We thank you for you for your trust and help.

Please check appropriate box.

Did ACH staff clearly explain what to expect during your hospice experience?

YesNoSomewhatN/A

Was ACH staff available to you 24 hours a day?

YesNoSomewhatN/A

Did you have complaints or concerns about your loved one’s care that were not resolved to your satisfaction? If "YES" please describe.

As a caregiver, did you benefit from the services provided by ACH?

YesNo

Did ACH staff work with you in a clear and concise manner to develop your loved one’s end-of- life plan?

YesNo

Did ACH staff prepare you and your family through bereavement services and counseling?

YesNo

Was our ACH staff knowledgeable?

YesNoSomewhat

Was our ACH staff professional?

YesNoSomewhat

Would you recommend Auburn Crest Hospice to family and friends?

YesNoPerhaps

Other Comments