Post Project Client Survey

2021 Post Project Survey

Contact Details

Name of Client

Phone

Diagnosis

I identify my ethnic background as:

I attest that the accessible home modifications performed on my home by Home Builders Foundation or their subcontractors through their home modification program is complete and to my satisfaction. Now that the work is complete, I understand that the modifications made by HBF (including but not limited to upkeep and maintenance) are now solely my responsibility.

Electronic Signature - Please type first and last name

Please let Home Builders Foundation know what we're doing well and how we can improve so we may provide the best possible service to future recipients.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
The modifications provided by HBF has increased my safety in my home.
The modifications provided by HBF has increased the safety of my caretaker(s).
The modifications provided by HBF have improved the quality of life for me and/or others in my household.
The modifications provided by HBF increased my accessibility to my community and the things I enjoy.
The work done by HBF has created more independence for me.
The work done by HBF has created more independence for those in my life.
I would refer a friend or family member to HBF.
My overall experience with HBF was positive.

How many people (including household members, client, and caregivers) were impacted by the modifications provided by HBF?

I want to stay connected with HBF in the future.

YesNo

If you answered Yes for the previous question, please indicate how you would like to be involved.

Please provide additional Comments on areas where HBF can improve.

Please provide additional Comments on what went well and/or how modifications by HBF have impacted your life.

Contact Information