Geriatric Evaluation and Management in The Home Satisfaction Survey

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Closes 30 Jun 2021


1. Date:
Demographic (Required)



2. Who is completing this survey?
3. Age of the patient (years)?
If you enter your email address then you will automatically receive an acknowledgement email when you submit your response.
4. Is the patient of Aboriginal and/or Torres Strait Islander origin?
5. Does the patient speak a language other than English at Home?
6. Services received
7. Does the patient have a long-term health condition, impairment or disability that restricts you in everyday activities and which has lasted, or is likely to last, for six months or more?
8. Staff were friendly and polite during visits
9. I was given contact details for the service to use if needed
10. I found written information about the service was helpful and easy to understand
11. My care was well coordinated (things went smoothly)
12. Any concerns or complaints were handled well?
13. I would be happy to use this service again
14. Are there any additional professionals or staffing you think may have beneficial whilst you were receiving Hospital in the Home services?
15. Why?
16. Would you prefer to be seen at home or in a hospital for the treatment you are receiving?
17. Why?
18. Was there a staff member who provided excellent care or service that you would like to tell us about?
19. Tell us what you liked the most about your hospital in the home experience?
20. Tell us what you liked the least about your hospital in the home experience?
21. Do you have any other comments or feedback about the Hospital in the Home service?
22. If you would like us to contact you regarding any concerns you may have regarding our service, please provide your contact details below.