Yahweh Care
Activity Log
Signout
Client Exit Form
Client Feedback
Staff Feedback Form
Client Exit / Termination Feedback Form
Client Exit / Termination Feedback Form
We truly value your honest feedback. Your response will help us improve and better support others in the future.
Name :
Date:
1. Reason for Ending Services:
Change of provider
Service not meeting expectations
Staff-related concerns
Communication issues
Relocation
Personal reasons
Other
Other
(You can select more than one)
2. Overall Experience with Yahweh Care:
Very Positive
Positive
Neutral
Negative
Very Negative
3. What Went Well?
(We want to keep doing this)
4. What Could We Have Done Better?
(Be honest – this helps us improve)
5. Staff Feedback:
Did you experience any issues with staff?
No issues
Minor issues
Major concerns
If yes, please explain:
6. Communication Feedback:
How was our communication?
Excellent
Good
Needs improvement
Poor
7. Did You Raise These Issues With Us Before?
Yes
No
8. What Would Have Made You Stay?
If yes, were they resolved?
Yes
No
9. Would You Consider Returning in the Future?
Yes
No
Maybe
10. Final Comments:
Submit
If you are human, leave this field blank.