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Full Nombre : 
Diagnosico   : 
 Edad  : 
Plan de rehabilitación  : 
 
 
 
Does the nurse follow your rehabilitation plan? 
 
De ningún modo
 
satisfactorio
 
Bien
 
Muy bien
 
Excellente

 
 
 
Does the nurse give the correct medications and proceedures, at the correct time?
 
Nunca
 
A veces
 
siempre
 
Correct time
 
Correct medications

 
 
 
How comfortable do you feel with the nurse ?
 
I am completely satisfied
 
Moderately satisfied
 
I am not satisfied, if so please explain in Q5

 
 
 
Please rank (1-3) the following in order of interest:
Rehabilitation Plan
Turning up to work on time
Medication administrating
Building a rapport
 
 
 
How often is the nurse late for work?
 
Nunca
 
1-2 times a fortnight
 
2-4 times a fortnight
 
Unsatisfied - please report in question
 
 
 
Please write what the nurse needs to improve on to benefit your experience with Atend:
   
 
 
 
What does Atend need to do for you? 
 
Follow-up with the nurse
 
Complete another rehabilitation Plan
 
Complete an TO
 
No, at present I am satisfied with the service