Retirement home satisfaction survey

Dear Sir/Madam,
Please take a short moment and fill in this retirement home satisfaction survey. The results of the questionnaire will be utilized by us so the retirement home resident experience continually refines.

1) For how long have you been living in our retirement home?*

Less than half a year

Between half a year to one year

One year to two years

Two years to five years

Five years to ten years

More than ten years

2) How satisfied are you with the common areas of the retirement home?*

	Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very dissatisfied
Accessibility
Cleanness
Comfort
Equipment
Spaciousness

3) How satisfied are you with the room you are accommodated at?*

	Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very dissatisfied
Accessibility
Cleanness
Comfort
Equipment
Serenity
Spaciousness

4) How satisfied are you with the food and beverages available in our retirement home?*

	Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very dissatisfied
Freshness
Presentation
Quality
Quantity
Variety

5) If you have a dietary restriction, do you feel that you are well supported?

Yes

6) How satisfied are you with the conduct of our staff?*

	Excellent	Very good	Good	Fair	Poor
Cheerfulness
Helpfulness
Kindness
Pleasantness
Professionalism
Swiftness

7) Do you miss some equipment required for your favorite leisure activity?*

Yes, I am missing:

8) Overall, how satisfied are you with our retirement home?*

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

9) How likely is it for you to recommend our retirement home to the people you know?*

10 (Virtually certain)9876543210 (Not likely at all)

10) Do you have any comments or suggestions on how we can improve the experience with our retirement home?

*Answer required

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