Pediatric Healthcare Connection - Patient Survey

Pediatric Healthcare Connection recently provided services to you. We want to ensure that we met your needs and provide quality care. You can help us by rating our service by responding to the following questions.

Rating: 1 = Poor  |  2 = Fair  |  3 = Average  |  4 = Good  |  5 = Excellent


1. Do you feel you have good communication with your supervising nurse?

2. Do your nurses arrive on time?

3. Do you feel the nurse(s) provide quality care?

4. Has the agency met your expectation for continuity of care?

5. Does the agency provide timely follow up to your concerns?

6. Were you informed timely to changes of care ?

7. Your overall rating of the agency was:

8. Would you recommend this agency to a friend or relative?

Please complete this form so we can meet your needs in the future and if a problem exists, can correct it. We are dependent on your input.

Your name and signature is optional. If you do elect to sign the form, would you allow us to call you to clarify any questions?

Thank you for completing this form.