“QUESTIONS TO ASK” WORKSHEET
The following is a questionnaire of healthcare services in nursing homes.
Making the right choice is easier when you thoroughly evaluate each facility
using these criteria. Most of all, if you are seeking a nursing home for someone
who cannot visit the facility personally, it is important to respect their needs
and wishes by including them in the process as much as possible. The result
will be their greater satisfaction.
Fill in the information below for each facility you visit. On the following pages, circle Y or N for
each question. This worksheet will give you a direct comparison for up to three facilities.
Facility: ________________________________________________________ ______________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
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Facility: ________________________________________________________ ______________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
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Facility: ________________________________________________________ ______________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
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Nursing Homes
Evaluate & Choose
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