Bereavement Program Service Evaluation
For the following questions, please rate each part of our Northeast Ohio Hospice bereavement program that you may have accessed, noting how helpful it was for you. Use the ranking scale of 0 being Not Helpful through 5 being Very Helpful. If you did not use service, check “N/A”.
I received mailings/newsletters from Hospice.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
I had phone contact with a Hospice staff member or a bereavement volunteer.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
I had visits from a member of the Hospice team.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
I attended the Hospice memorial service.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
I attended one or more support groups at Hospice.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
A Hospice staff member or volunteer attended the funeral or visitation.
*
Yes
No
N/A
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
Did Hospice's support services help you to cope with the changes in your life following the loss of your loved one?
*
Yes
No
How helpful was this?
Not Helpful
1
2
3
4
Very Helpful
5
1 is Not Helpful, 5 is Very Helpful
With the assistance and services that were provided by Northeast Ohio Hospice, I feel that I better understand and have learned to cope with the grief process:
*
Not at all
1
2
3
4
Very Well
5
1 is Not at all, 5 is Very Well
Comments:
If there was one thing Northeast Ohio Hospice could do better in providing bereavement services, what would it be?
Thank you for taking the time to complete this questionnaire. Please remember, all of our services remain available to you. If you would like to talk to someone, please call the Bereavement Counselor at (216) 472-2684.
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