2024 Satisfaction Survey (Families/Caregivers)

2024 Satisfaction Survey - Families & Caregivers

Please take this 2-minute survey. The information you provide will help us support our strategic planning efforts and assist us in maintaining the highest quality of services for your family member. Kindly respond by October 31, 2024.
This form is HIPPA Compliant. All information is confidential.
Who is filling out this form?*

Family MemberSiblingOther Family MemberOther Caregiver

We are updating our records. Please complete information below. Thank you
I prefer to be contacted by:*

EmailPhoneText MessageTraditional Postal MailAll of the above
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
If you have any questions or would like a paper survey form, please email info@arcwestchester.org Thank you for your feedback!
Should be Empty:

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
Keeps me informed
Help people feel safe
Provides a comfortable environment
Encourages my involvement
Promotes health and wellness
Cultivates healthy relationships
Supports lifelong learning
Fosters independence
Staff are supportive and respectful
Staff respond to my concerns

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
Participating in outdoor activities and being part of the community is essential for overall well-being.
Being able to express oneself, having a voice, being heard, make choices, and stand up for one’s needs is crucial for personal growth, self-esteem and living a fulfilled life.
To be a more responsive staff member, it is important to recognize and appreciate the different ways people show happiness and dissatisfaction to better meet their needs.
Incorporating more plant-based options into meals is important for promoting a healthier lifestyle.

2024 Satisfaction Survey - Families & Caregivers