Brookline Community Aging Network

Service Referral Program
Member Feedback

What service provider did you access through the BrooklineCAN Service Referral Program?

Please rate your overall satisfaction:
Excellent, Good, Fair, Poor, Not Applicable

BrooklineCAN	E	G	F	P	NA
The interaction with Senior Center/BrooklineCAN Staff?
The usefulness of the information provided?

Service Provider	E	G	F	P	NA
The quality of the work of the provider you selected?
The ease of communicating with the provider?
The clean-up after the provider completed the work?
The cost of the work the provider performed?

If you rated any of the above questions fair or poor, please explain:

Would you recommend this provider to your friends and neighbors?
Yes No
What comments would you make about your experience:
Has this service had a positive impact on your ability to remain in your home longer than you would have expected? Yes No
What do you believe will be most helpful to improve services that assist seniors to remain in their homes in Brookline?
What category(s) would you be interested to see the Service Referral Program expand to next?
Appliance Repair
Roofing Contractor
Rug Cleaning Company
Landscaping/Lawn Maintenance
HVAC (Heating, Ventilation, Air Conditioning)
Other
Do you have a trusted service provider you would like to recommend to the Service Referral Program? Please list below:
May we use your name as an additional reference for this service provider? Yes No