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In order to help maintain the highest standards, we would appreciate your feedback about your stay at the Dallas Retirement Village Health and Rehabilitation Center.
What type of treatment did you receive?
(Check all that apply)
Skilled Nursing
Injury/Wound
Rehab
IV
Other
Other
*
Overall Satisfaction
Please rate the following aspects at Dallas Retirement Village.
Very Satisfied
Very Unsatisfied
Customer Service
1
2
3
4
5
N/A
Professionalism / Knowledge of staff
1
2
3
4
5
N/A
Effectiveness of treatment
1
2
3
4
5
N/A
Quality of equipment / Surroundings
1
2
3
4
5
N/A
Comfort of accommodations
1
2
3
4
5
N/A
Cleanliness of personal room and surroundings
1
2
3
4
5
N/A
Responsiveness to my needs
1
2
3
4
5
N/A
Quality of dining service
1
2
3
4
5
N/A
Likelihood of recommending our services to a friend
1
2
3
4
5
N/A
Thank you for completing this survey.
If you would like a response, please provide your contact information.
Name
Phone
Email
Comments
Name
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