Follow-Up Survey

Thank you for your recent visit, tour, or other contact with Mission Healthcare at Bellevue. We value your opinion and invite you to evaluate how we’re doing using this short questionnaire. Your input will help us better understand both our strengths and, more importantly, where we need to improve.

1. What type of contact with us did you have?
Took A Tour
Visited A Resident
Worked As A Volunteer
Requested Information Or Help By Phone
Attended A Workshop Or Seminar
Other

2. Based on that contact, how would you rate our staff?

Staff was...
	Outstanding	Good	Adequate	Bad	Very Bad
friendly & courteous:
organized & on time:
well informed & professional:
respectful & caring:
successful in meeting my needs:

3. What would you list as a particular strength of Mission Healthcare?

4. What would you name as one thing you would like to see us improve on?

5. Based on your recent contact with us, would you recommend us to others?
Definitely
Probably
Maybe
Probably Not
Definitely Not

6. If you are comfortable doing so, please include your name, contact information, and more about your recent contact with us:

Name:

Address:

City, State Zip:

Phone:

E-mail:

Please enter any additional comments here:

If you can see the field below, please leave it blank.