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Home Care Feedback Form Template
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1. The care content was useful and engaging
Strongly Disagree
Strongly Agree
1
2
3
4
5
2. The care was well organised
Strongly Disagree
Strongly Agree
1
2
3
4
5
3. Were the services adequate?
Strongly Disagree
Strongly Agree
1
2
3
4
5
4. Did the services meet your expectations?
Strongly Disagree
Strongly Agree
1
2
3
4
5
5. How would you rate our external services?
Poor
Excellent
1
2
3
4
6. How would you rate the carer who visited?
Poor
Excellent
1
2
3
4
7. Was sufficient time provided for questions and discussion?
Yes
No
8. Do you feel you can help improve the care?
Yes
No
9. What aspects of the care could we improve?
10. What else would you like to see added to your services?
Evaluation object score
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