Community Based Services

FEEDBACK REQUEST
As CBS is continually striving to improve service, we are interested in your comments! It would be helpful if you took a moment to briefly answer a few simple questions about your visit.

Which of our homes did you visit?
Broad Street
Bryant Avenue
Fairmount Road
Hawkes Close
Henry Street
Lower Shad Road
Ridge Street
Willow Drive
Which best describes you?
Family Member
Therapist
Contracted Employee
Medical Professional
Approximately how long have you been affiliated with CBS?
0-2 Years
2-6 Years
6-12 Years
More than 12 Years
Approximately how frequently do you visit this house?
Weekly
Monthly
6-9 times Per Year
Annually
Approximately how long were you in the house today?
Less than 30 minutes
30 to 60 minutes
1 to 2 hours
Over 2 hours

Please select the number which most closely describes your experience today

Did staff greet you appropriately?
Were the staff involved with the individuals?
Did the house look clean and well maintained?
Were the individuals appropriately dressed and groomed?
Did the environment appear safe and free of unnecessary hazards?
Did you feel welcome in the house?
Were staff meeting the needs/ requests of the individuals?
Was adequate supervision apparaent?
Were meaningful activities observed?
Overall, was your visit enjoyable for you and your loved one?

Please tell us if you have any other comments or suggestions relating to your visit.