Brookline Community Aging Network

 

 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

 
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