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 Service Referral Program
Member Feedback

Please submit a separate form for each provider

  1. What service provider did you access through the BrooklineCAN Service Referral Program?
  2. Please rate your overall satisfaction:
    Excellent, Good, Fair, Poor, Not Applicable
    BrooklineCANEGFPNA
    The interaction with Senior Center/BrooklineCAN Staff?
    The usefulness of the information provided?

    Service ProviderEGFPNA
    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:
  3. Would you recommend this provider to your friends and neighbors?
    Yes No
  4. What comments would you make about your experience:
  5. Has this service had a positive impact on your ability to remain in your home longer than you would have expected? Yes No
  6. What do you believe will be most helpful to improve services that assist seniors to remain in their homes in Brookline?
  7. 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
  8. Do you have a trusted service provider you would like to recommend to the Service Referral Program? Please list below:
  9. May we use your name as an additional reference for this service provider? Yes No

  Test dialog X
AddressFor
General questions or comments
Email for BrooklineCAN's Livable Community Advocacy Committee
Submissions for our “Links” page
Press releases and other media communication
Membership discussion
Newsletter feedback or suggestions; any issues for the communications committee
Comments about our website

Support Disclaimer: Inclusion of services on this website does not represent a recommendation from the Brookline Council on Aging, the Brookline Senior Center, or the Brookline Community Aging Network.

Disclaimer: Inclusion of services through this program does not represent a recommendation or guarantee of work performance from the Brookline Council on Aging, the Brookline Senior Center, or the Brookline Community Aging Network. The user of this program therefore agrees to release the above named from any and all liability. The user should make whatever investigation or other resources that they deem necessary or appropriate before hiring or engaging Service Providers.