* = Required Information

1.Did the staff member(s) arrive when you expected them?

YesNo

2. Did you know what day the staff member(s) was scheduled? or call prior to services.

YesNo

3. Have the staff member(s) been friendly and courteous?

YesNo

4. Have the staff member(s) been able to answer your questions?

YesNo

5. Did you feel you learned enough about your health problem and medicine?

YesNo

6. Are you pleased with your major clinical home health care services?

YesNo

7. Were you told when services changed or was going to end?

YesNo

8. Have you discussed your Home Health Experience with your Physician?

YesNo

9. Would you recommend our services to a friend or use Legend Home Health again?

YesNo

10. Do you have any suggestions to improve the care and services you received?

YesNo

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