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Exit Survey
 
 
Are you satisfied with your current home care services ?
   
 
 
 
How often do you need or would like services ?
 
Weekly
 
Bi-weekly
 
Hourly
 
 
 
How often do you need to travel ?
 
Weekly
 
Monthly
 
Quarterly
 
 
 
How important is your appearance and will you want these services included in your care plan ?
 
Yes no
 
Weekly
 
Bi weekly
 
 
 
Do your agency have any rewards or perks for you or your family members ?
 
 
 
Would you be interested in learning more about our home care agency if unsatisfied with your current home care services
 
Yes
 
No
 
 
 
What are your immediate concerns about new home care agencies ?
 
Trust issues
 
Having a stranger in my home
 
Theft
 
I don't need home care assistance
 
 
 
What services would you love to have upon signing up with our agency ?
 
Weekly
 
Bi-weekly
 
Hourly
 
 
 
Would you like to try our services for 1 hour for free ?
 
Yes explain
 
 
 
No explain
 
 
 
Would you like a home care agency to provide special perks / rewards upon signing up ?
 
How often