Bernadette Home Care – Feedback Form Your feedback helps us serve you and your loved ones better. Name Optional Email or Phone Optional Relation to Resident Resident Family Member Friend Visitor Other Optional Location Visited / Receiving Care Echo St, Oxnard Marissa Ln, Camarillo Lathan Ave, Camarillo Dunnigan St, Camarillo Dapple Ave, Camarillo Area 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Overall quality of care 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Staff professionalism and kindness 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Cleanliness and comfort of the home 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Communication with staff/management 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Responsiveness to concerns or requests 1 2 3 4 5 Rate your experience from 1 (poor) to 5 (excellent) Comments or Suggestions Please share any feedback, compliments, or areas where we can improve: Would you recommend Bernadette Home Care to others? Yes No Maybe May we use your comment (anonymously or with your first name) for marketing or testimonial purposes? Yes No Optional Submit
