This printable aged care family satisfaction survey helps residential aged care homes gather honest feedback from the families of their residents across 17 questions, including relatives who never open an email. The form prints on three pages and takes about ten minutes to complete.
What this survey measures
The survey focuses on what matters most to families: the quality and safety of care, whether staff treat their loved one with dignity and respect, health and personal care such as medicines, pain management and access to a doctor, how well the team communicates with the family and handles concerns, whether meals, activities and surroundings meet the resident's needs, and how clearly fees, invoices and changes to services are handled. A short profile section lets you compare results by relationship, length of stay and type of care. An overall rating and a recommendation question give you simple scores to track over time, and two comment boxes invite families to tell you what works well and what could be better.
How to use it on paper
Mail the survey to families with a reply-paid envelope, or leave copies at reception with a drop box for visiting relatives. Families fill the checkboxes with a blue or black pen and write any comments in the space provided. Collect the completed forms and scan them in batches: PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results appear in your dashboard with no manual data entry.
Customize this template
Add your home's logo, reword the statements to match your services, or add questions about specific wings or care teams. The paper layout reflows automatically as you edit, and every copy you print stays scannable.
Preview the PDF above, or use this template to start collecting family feedback today.