Home Care Feedback Form
We value your feedback to improve our services. Please take a few minutes to share your thoughts about the care provided.
Service User Details:
Service User's Name
Person completing the Form, if not the Service-User
Date of feedback
/
Day
/
Month
Year
Date
Carer(s) you are giving feedback about (optional): You can write “Higham Carers” if it is not about a specific carer.
Quality of Care:
How would you rate the overall care provided?
Excellent
Good
Fair
Poor
Caregiver's Professionalism
The caregiver is respectful, punctual, and professional.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Communication
The caregiver and/or agency communicates clearly and keeps me informed.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Responsiveness
The caregiver/agency responds promptly to needs or concerns.
Excellent
Good
Fair
Poor
Reliability
The caregiver shows up consistently and completes tasks as expected.
Always
Usually
Sometimes
Rarely
Safety and Comfort
The caregiver ensures the client feels safe, comfortable, and respected.
Always
Usually
Sometimes
Rarely
Overall Satisfaction
Very Satisfied
satisfied
Neutral
Dissatisfied
Very Dissatisfied
Open Feedback
What do you feel is going well?
What could be improved?
Additional comments:
SUBMIT
Should be Empty: