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Assisted Living Move-Out Survey Questions

Updated over 2 months ago

The room and community was clean.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

The transfer of medical records, medications, and prescription information was smooth.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

The staff was friendly and attentive.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

On a scale of 1 to 10, how likely are you to recommend Our Care Community to a friend or colleague?

  • 0 (Not at all likely)

  • 1

  • 2

  • 3

  • 4

  • 5

  • 6

  • 7

  • 8

  • 9

  • 10 (Extremely likely)

Is there any additional context you would like to share?

Open text response.

Please check the reason(s) for moving out. Select all that apply:

  • Medical reasons

  • Financial reasons

  • Desire for more independence

  • Family decision

  • Dissatisfaction with care/services

  • Moving to a different facility

  • Other (please specify in the above question)

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