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Surveys
2014
February
Q
QuestionPro : Company Satisfaction
QuestionPro : Company Satisfaction
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Exit Survey
Dear referrers
You are invited to participate in our survey. In this survey, approximately 20 people will be asked to complete a questionnaire about the Lane Cove and North Side Community Home Nursing service. The survey will take approximately 5 minutes to complete.
Your participation in this survey is very important to us. The home nursing service is constantly aiming to improve our care and increase our client numbers. Our aim is to provide the a professional and efficient service that meets both yours and our clients needs.Your input is vital to our ability to achieve this.
Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Michele Neil (Acting Nurse manager) at 9427 6425 or by email at
[email protected]
.
Thank you very much for your time and support.
How long have you used the Lane Cove Home Nursing Service?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
Which of our [PRODUCTS/SERVICES] do you use? Select all that apply.
{OPTION 1}
{OPTION 2}
{OPTION 3}
{OPTION 4}
{OPTION 5}
How frequently do you refer to our service?
Every 2 - 3 weeks
Every month
Every 2 - 3 months
Every 4 - 6 months
Once or twice a year
How would you rate your level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
How much do you rate us on the following attributes?
Well Below Average
Below Average
Average
Above Average
Well Above Average
Customer service
Professionalism
Quality of service
Understanding customers' needs
Nursing staff
Price
Comment:
How likely are you to continue doing business with us?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
How likely is it that you would recommend our [PRODUCTS/SERVICES] to a friend or colleague?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
Do you have any suggestions for improving our [PRODUCTS/SERVICES]?
What is your gender?
Male
Female
Prefer not to answer
Which category describes your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
Not employed, but looking for work
Not employed, not looking for work
Retired
Student
Military
Homemaker
Prefer not to answer
Other
Which of the following categories best describes the industry you work in?
Automotive
Advertising
Consulting Services
Education
Entertainment
Financial Services
Government Services
Healthcare
Human Resources
Information Technology
Marketing/Sales
Non-Profit
Pharmaceuticals
Public Relations
Technical Services
Travel
Other
Which category best describes your annual income?
Under $15,000
$15,000 - $29,999
$30,000 - $44,999
$45,000 - $59,999
$60,000 - $74,999
$75,000 - $89,999
$90,000 or more
Prefer not to answer
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