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PLEASE FILL OUT QUICK SURVEY FORM
ALL FIELDS ARE REQUIRED!
To ensure the highest level of care, client satisfaction surveys are periodically collected and reviewed. Harmony Homes of Miami uses the survey results to maintain the highest level of performance possible. We will keep all information private and confidential. Please take a moment to let us know how you feel about Harmony Homes of Miami We are dedicated to giving you the friendliest most professional service available.
How would you rate the services you received from Harmony Homes of Miami?
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Poor
Fair
Avarage
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Excellent
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If home health care services were needed again, would you use Harmony Homes of Miami?
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Yes
No
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How would you rate our ability to answer your questions when contacting us?
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Excellent
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How satisfied are you with the services you received for the following disciplines? If you did not receive this type of service please select "Service Not Applicable".
A value is requ
Skilled Nursing Service
Poor
Fair
Avarage
Good
Excellent
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Speech Therapy Services?
Poor
Fair
Avarage
Good
Excellent
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Physical Therapy Services?
Poor
Fair
Avarage
Good
Excellent
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Social Services?
Poor
Fair
Avarage
Good
Excellent
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Occupational Therapy Services?
Poor
Fair
Avarage
Good
Excellent
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Home Health Aide Services?
Poor
Fair
Avarage
Good
Excellent
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Overall satisfaction with Harmony Homes of Miami?
Poor
Fair
Avarage
Good
Excellent
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Additional Comments or Recommendations
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Patient Name:
Patient Number: (if known)
Phone Number:
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