Usertick
Start free
Home care survey template

Know how each visit went, from the family's side of the door

Three questions for clients and their families after home care visits: whether the caregiver arrived on time, how the caregiver, respect, agreed tasks and communication rated, and what to change next time. Use it as it is or change any question, and Usertick reads every written answer for you.

Get started freeAll templates

What this home care survey tells you

A home care satisfaction survey asks clients and their families about the visits that happen when no manager is in the room: whether the caregiver came at the expected time, how they treated the client, whether they did what was agreed and how well they kept the family informed. This template asks three questions in about a minute.

It is written for the family contact, sent by Usertick email at a regular point in the week. Usertick has no recurring sends, so schedule each send yourself, up to 30 days ahead, and turn off Skip people who already received this survey so the same families can answer again. Clients can also answer by a link or a QR code kept in the care folder at home.

Results shows the share of visits where the caregiver arrived on time and a heat map of the four rows with row averages. The written answer is read as it arrives and filed under a category such as staff and communication or booking and appointments, with a type and an urgency, so a concern about a caregiver stands out in the inbox the day it comes in.

In an emailAs a linkOn your websiteAs a conversation
Questions
3
Time to answer
About a minute
Written for
Once a week, by email to the family contact
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, with the first question inside the email. A tap on an answer opens the rest of the survey with that answer already kept. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 3 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 3 · Yes / No

Did the caregiver arrive at the expected time?

Why ask it
A late or missed visit is the problem families notice first, because the client is waiting for help to get up, eat or start the day. A yes or no makes punctuality easy to count week by week.
What you learn
The share that said yes, against the period before. Choose No to see how those families rated communication, since a late visit with a call ahead is a different week from one without.
Make it yours
Keep it first, so families answer inside the email with one tap and the rest of the survey opens with it kept.
Question 2 of 3 · Matrix · Optional

How would you rate the following?

Why ask it
Four rows cover what families judge a home care service on: the caregiver as a person, respect and dignity, doing the tasks that were agreed and keeping the family informed.
What you learn
A heat map per row with row averages, so a low row such as communication with the family points to a fix in the office.
Make it yours
When families see more than one caregiver, add a Dropdown that names the caregiver, since Results doesn't split answers by the tag on a link.
Question 3 of 3 · Text · Optional

Is there anything we should change for the next visit?

Why ask it
The last question asks for one change before the next visit, which gives the care coordinator something specific to act on.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a complaint, an idea or praise and flags the urgent ones.
Make it yours
On every plan, a workflow can post every response that becomes urgent to Slack or Microsoft Teams, so the care coordinator sees it before the next visit.

What the answers show

Results turns each question into numbers you can follow week by week.

How would you rate the following?

Each row's answers side by side, so the part that needs work stands out.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Home care visit in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Schedule each week's send

    Usertick has no recurring sends, so schedule the next send when you review this week's answers, up to 30 days ahead.

  2. 02

    Let families answer every week

    Turn off Skip people who already received this survey, which is on by default, so the same family contact can answer each week.

  3. 03

    Follow up on every late visit

    Give each response where the caregiver arrived late an owner in the inbox, and note what the office changed.

  4. 04

    Keep care details out

    Ask about punctuality, respect and communication, never the client's condition or care plan. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

CSAT surveysPatient satisfaction surveysEmail surveysCare at home questions

More satisfaction templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

Browse all templates
CSATAppointment experienceLearn how patients experienced a visit, from booking and waiting to how clearly things were explained and what happens next. Send it the same day, and keep it free of medical details.
CSATPharmacy visitLearn how customers rated a pharmacy visit, the wait and how clearly the medicine was explained. Share it on the receipt with a QR code.
CSATDental visitLearn how patients rated their dental visit, from comfort in the chair to how clearly costs were explained. Send it the same day.
CSATPhysical therapy sessionCheck how patients feel after a session and whether their home exercises and treatment plan are clear. Send it an hour after each session.

Questions from the library

Browse the question library
  1. How would you rate the care you get at home?Stars · Care at home
  2. Do the visits happen when they are meant to?Yes / No · Care at home
  3. How many visits do you get in a normal week?Number · Care at home
  4. How many hours were you there in total?Ruler · Urgent care visits
  5. How did you decide to come in?Multiple choice · Urgent care visits
  6. Were you told how long the wait would be?Yes / No · Urgent care visits

Frequently asked questions

Weekly suits families who follow the care closely, and monthly suits a steady service. Usertick has no recurring sends, so schedule each send yourself, up to 30 days ahead.

The family contact who follows the care, or the client when they can answer. Each person needs a contact with an email, from a CSV import or a Contact question.

Few enough to answer every week without tiring of it. This template asks three and takes about a minute.

Yes, with a Dropdown that names the caregiver. Select a name in Results to narrow the whole page to the answers about that caregiver.

Read it the day it comes in, give it an owner in the inbox and call the family. Usertick flags urgent answers, so a serious concern is easy to find first.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

Listen better, act faster, and build what truly matters.

Start free, see what your customers mean, and get each answer to the person who can act on it.

Get started freeTalk to sales
  • 150 responses a month on Free
  • Every channel and AI analysis
  • No card needed