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New Survey: Survey - Respite Individual


 
Header - Survey Questions
Header Section - #95B3D7
Q1a *
On a scale of 1 to 10, how likely is it that you would recommend this service to a friend? With 10 being the highest and 1 being the lowest
Q1b *
Do you like going to Respite?
Q2 *
Do you like your Respite Caregiver?
Q3 *
When you go to respite, do you get to participate in activities?
Q4 *
Do you get to decide what to do during your respite visit (ie: food you eat, things you do)?
Q5 *
Do you know who the Respite Manager is?
Is an immediate follow-up required by CSCL?
Would you like someone from CSCL's Leadership team to follow up with you regarding any concerns?
Comments
Header - Optional Questions:
Header Section - #95B3D7
Name (Optional)
Header - Post Survey/Administration Section:
Header Section - #95B3D7
Date of Survey
Select a date from the calendar.
Staff/Caregiver (If Assisted)
Service
Survey Time
How long did it take to complete this survey (in minutes)?
Follow Up Required?
Is an immediate follow-up required by CSCL?
Year
Header - Management Section:
Header Section - #95B3D7
View *