Service Survey

You have been invited to complete this short questionnaire to help improve our services based on your experience. All information provided will be treated in the strictest confidence and will not be disclosed to your carer.

All information will be processed and stored in accordance with the Data Protection Act and our Privacy Policy.

If you do not wish to provide your personal details please leave the fields as blank. All fields marked with (*) should be completed.


Your Details

Your Name:Your Email:
Your Contact No:Postcode:

Care Details

Date of Care*:Time (From - To)*:

The Carer

Did the carer arrive on time:YesNo
Did the carer show you any identification:YesNo
Did the carer ask about how you were feeling:YesNo
Was the carer friendly:YesNo
Did the carer explain everything that they were doing:YesNo
Did have any difficulties understanding the carer:YesNo
Did the carer perform all the tasks as expected:YesNo
Did the carer leave at the correct time:YesNo
Did the carer make sure that the premises was safe and secure:YesNo
Would like the same carer to comeback again:YesNo


How would you rate the service you received on this occassion.
ExcellentGoodAverageBadVery Poor
Do you think enough was done to meet your needs.
Strongly AgreeSomewhat AgreeNot SureSomewhat DisagreeStrongly Disagree
Describe your carer in one word.

Thank you for completing the survey. All information provided will be kept private and confidential. It is only used for improving the services we provide.

If your have queries or complaints about our services please contact our Quality Team on 01536 000 000.