Welcome to Atlantic Coast!

During my rehab stay I enjoyed warmth, skill, and compassion from each and every one of your staff.”

By sharing your evaluation and comments with us, you will help us maintain our high standards of care.

E = Excellent
G = Good
F = Fair
P = Poor

Y = Yes
N = No

Nursing Services	E	G	F	P
Nurses Services
Nurses assistant services
Explanation of your medical care and treatment
Courtesy and Professionalism of Nursing Staff
Courtesy and Professionalism of Nursing Staff
Promptness of Response
Comments

Housekeeping/Laundry	E	G	F	P
Cleanliness of Room
Cleanliness of Facility
Courtesy of Housekeeping Staff
Quality of Laundry Services
Comments

Food Service	E	G	F	P
Variety of Menu
Quality of Food
Courtesy/ Helpfulness of Dietary Staff
Responsiveness of Dietician

Rehabilitation Services	E	G	F	P
Physical Therapist
Occupational Therapy
Speech Therapy
Courtesy/Helpfulness of Staff
Resident’s involvement in goal setting.
	Y	N
Achievement of gaols?
Comments

Activities/Recreation	E	G	F	P
Quality of activities
Variety of activities
Courtesy/ Professionalism of Staff
Comments

Social Services	E	G	F	P
Availability of Staff
Courtesy/Professionalism of Staff
Quality of Services
Responsiveness to concern
Comments

Admissions	E	G	F	P
Availability of Staff
Knowledge/Helpfulness of Staff
Responsiveness to concern
Comments

Business Office	E	G	F	P
Accuracy of Billing
Availablity of Staff
Courtesy/Responsiveness of staff
Comments

Management Services	E	G	F	P
Administrator Availability
Responsiveness to your needs
Comments

Is there a specific staff member that you would like to commend for his/her special effort in making you or your family member’s stay a positive one?

Name

Department

Why did you choose Atlantic Coast? Choose as many as apply.

Reputation
Physician Recommendation
Specialized Service
Relative/Friend Recommendation
Location
Hospital Referral
Other (write below):