1. How long have you used our services?
Less than a month1-12 months1-3 years3-5 yearsMore than 5 years

2. Which services do/did you receive?
Homemaker ServicesOther

3. How often do/did you receive our services?
2-4 hours per day5-8 hours per day17-24 hours per dayOther

4. I am satisfied with the services I receive from Independent Residential Management Training.

Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

5. I am satisfied with the quality of the services I received.
Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

6. I feel the staff members were competent and had the skills necessary to care for me.
Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

7. I am satisfied with Independent Residential Management Training's Staffing/Scheduling Department.
Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

8. I am satisfied with the on-call services that are available after hours.
Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

9. I am satisfied with Independent Residential Management Training's Administration Department.
Strongly AgreeAgreeNo OpinionDisagreeStrongly Disagree

10. Overall, how would you rate Independent Residential Management Training’s services compared to our competitors?
Much BetterSomewhat BetterSameSomewhat WorseMuch WorseNo Opinion

11. How satisfied are you with our services overall?
Extremely SatisfiedQuite SatisfiedSomewhat SatisfiedNeutralSomewhat DissatisfiedQuite DissatisfiedExtremely Dissatisfied

12. I would recommend Independent Residential Management Training’s services to friends and/or family.
Strongly agreeAgreeNo OpinionDisagreeStrongly disagree

13. What impressed you most about our services?

14. What disappointed you most about our services?

15. Additional suggestions you would like to share

16. Name:

17. Email address:

18. Date:

19. Phone number: