Satisfaction survey

Are You:

A resident of a long-term care facility
A friend or family member
Other

How did you initially have contact with the ombudsman?

The ombudsman visited or called
I contacted the ombudsman
Other

Did the ombudsman understand your concerns?

Yes
No

Once you shared your concerns, did the ombudsman act promptly to help you?

Yes
No

Did the ombudsman maintain contact with you during the investigation?

Yes
No

Did the ombudsman resolve your concern to your satisfaction?

Yes
No

Was the ombudsman courteous and respectful?

Yes
No

Would you contact the ombudsman if you needed further assistance?

Yes
No

Kansas Long-Term Care Ombudsman Program Feedback ​Form