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Community Living Center (CLC) Satisfaction Survey
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Community Living Center (CLC) Satisfaction Survey |
| Author | VHAOKLSTEPHA |
| Last Modified By | Writer |
| File Modified | 2012-05-07 |
| File Created | 2026-09-21 |
| Conversion State | complete |
Extracted Text
Community Living Center (CLC) Resident Satisfaction Survey
Oklahoma City VA Medical Center
This is a voluntary survey about your CLC experience. Your ratings help improve our service to you and others. Circle the rating that best describes your satisfaction with the CLC. Feel free to add comments.
1. Facilities – How would you rate the CLC facilities overall?
Does not apply Poor Fair Good Very Good Excellent
Comments_________________________________________________________________
2. Concern and caring by CLC medical providers (doctor, physician assistant, nurse practitioner): Courtesy and respect you were given; friendliness and kindness.
Does not apply Poor Fair Good Very Good Excellent
Comments_________________________________________________________________
3. Nurse Services – Thinking about your CLC stay, how would you rate courtesy and respect shown to you by nurses?
Does not apply Poor Fair Good Very Good Excellent
Comments_________________________________________________________________
4. Physical Therapy – If you saw physical therapy during your CLC stay, how would
you rate the quality of the services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments_________________________________________________________________
5. Occupational Therapy – If you saw occupational therapy during your CLC stay,
how would you rate the quality of services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
6. Recreation Therapy (OASIS) – If you saw recreation therapy during your CLC stay,
how would you rate the quality of the services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
7. Social Work: If you saw a social worker during your CLC stay, how would you rate
the quality of the services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
8. Dietician: If you saw a dietician during your CLC stay, how would you rate the quality
of nutritional care you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
9. Speech Therapy – If you saw speech therapy during your CLC stay, how would you
rate the quality of the services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
10. Psychology – If you saw psychology during your CLC stay, how would you rate the quality of services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
11. Psychiatry –In terms of your satisfaction, how would you rate the psychiatry
doctor's explanation of what was done for you?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
12. Pharmacist – My pharmacist explained things thoroughly.
Does not Strongly Disagree Not Sure Agree Strongly
Apply Disagree Agree
Comments__________________________________________________________________
14. Chaplain – If you saw a Chaplain during your CLC stay, how would you rate the
quality of services you received?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
15. Thinking about your CLC stay, please rate how well you were helped?
Does not apply Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
16. Please rate your overall sense of safety on the CLC:
Poor Fair Good Very Good Excellent
Comments__________________________________________________________________
17. Please rate the overall quality of care and services on the CLC:
Poor Fair Good Very Good Excellent
18. Thinking about your CLC stay, how well did your CLC stay meet your needs?
Did not meet Partly met Fully met
my needs my needs my needs
Comments_____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________Name (Optional)___________