Post Project Survey

Contact Details

Client First Name

Last Name

Contact Email

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

Thinking about your safety, quality of life, and independence BEFORE the modifications provided by HBF please answer the following.

I feel safe when I am moving around my house doing routine activities such as bathing or cooking

I am satisfied with my quality of life in my home.

I feel independent when I am moving around my house doing routing activities such as bathing or cooking.

I am able to get out into the community easily and do things.

Now think about your safety, quality of life, and independence AFTER the modifications by HBF were completed.

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.

If you would like to share a picture of you with your modifications or enjoying a part of life your modifications made possible please upload here.

Contact Information