It only takes a
few minutes
of your time...

...to let us know
how we're doing.  
Have a favorite
Caregiver?  
Questions about
your schedule?  
Concerns about
billing?  We want
to hear about them!

Please take a
moment to fill out
this survey and
send it back to us.  
Your name and
contact
information are
optional, and any
complaints or
concerns will be
kept strictly
confidential unless
you state
otherwise.

We're looking
forward to
hearing from
you!
The Caregivers that Amazing Grace sends to my home are
consistent, dependable and provide exceptional care.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
I feel completely safe and secure in my home with Amazing
Grace's Caregivers.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Any complaints or concerns that I have expressed to Amazing
Grace are addressed and resolved quickly and to my
satisfaction.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
I would be comfortable voicing constructive criticism to the
Caregivers that Amazing Grace sends to my home.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
I am confident that I will be able to reach a member of
Amazing Grace's management team in the event of an
emercency.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Amazing Grace's Caregivers do a good job of keeping my
home neat and tidy.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Amazing Grace's Caregivers are always available to help me
when I ask.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Amazing Grace's Caregivers are always willing to go above
and beyond when I need more assistance than usual.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Amazing Grace's management team is accessible,
understanding and flexible.  They are always willing to do
what they can to meet my needs.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Amazing Grace Private Nursing Care, Inc. provides a
services that is well worth the money.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
I would feel confident recommending Amazing Grace Private
Nursing Care, Inc. to friends and family who are in need of
home care services.
Strongly                                                                                               Strongly
Disagree                                         Agree                                              Agree
Please feel free to provide any additional comments or
suggestions below.
Please check here if you wish to give your consent to Amazing Grace
Private Nursing Care, Inc. to use the above statements for marketing
purposes.
OPTIONAL INFORMATION
My Name:
I am...
...a client of Amazing Grace PNC, Inc.
...a family member of an Amazing Grace PNC, Inc.
client.
May we contact you to discuss your responses?
Yes
No
If yes, please provide your daytime telephone number below.