Copy of Patient Satisfaction Survey

1. What service(s) did you recieve from Great Land Infusion Pharmacy? Mark all that apply.

What service(s) did you recieve from Great Land Infusion Pharmacy? Mark all that apply. IV infusions

Nurisng

Retail pharmacy

Delivery of medications/supplies

2. How well did the pharmacist answer your questions?

	5	4	3	2	1	N/A
5 is excellent and 1 is poor.	*How well did the pharmacist answer your questions? 5 is excellent and 1 is poor. 5	5 is excellent and 1 is poor. 4	5 is excellent and 1 is poor. 3	5 is excellent and 1 is poor. 2	5 is excellent and 1 is poor. 1	5 is excellent and 1 is poor. N/A

3. How well did the nurse explain the therapy you received?

	5	4	3	2	1	N/A
5 being excellent and 1 being poor.	*How well did the nurse explain the therapy you received? 5 being excellent and 1 being poor. 5	5 being excellent and 1 being poor. 4	5 being excellent and 1 being poor. 3	5 being excellent and 1 being poor. 2	5 being excellent and 1 being poor. 1	5 being excellent and 1 being poor. N/A

4. How well did the delivery driver do delivering your therapy at the agreed upon time?

	5	4	3	2	1	N/A
5 being excellent and 1 being poor.	*How well did the delivery driver do delivering your therapy at the agreed upon time? 5 being excellent and 1 being poor. 5	5 being excellent and 1 being poor. 4	5 being excellent and 1 being poor. 3	5 being excellent and 1 being poor. 2	5 being excellent and 1 being poor. 1	5 being excellent and 1 being poor. N/A

5. How satisfactory was the agreed upon time for delivery of your therapy/drugs?

	5	4	3	2	1	N/A
5 being excelent and 1 being poor.	*How satisfactory was the agreed upon time for delivery of your therapy/drugs? 5 being excelent and 1 being poor. 5	5 being excelent and 1 being poor. 4	5 being excelent and 1 being poor. 3	5 being excelent and 1 being poor. 2	5 being excelent and 1 being poor. 1	5 being excelent and 1 being poor. N/A

6. How well were your "out of pocket" costs explained to you?

	5	4	3	2	1	N/A
5 being excellent and 1 being poor.	*How well were your "out of pocket" costs explained to you? 5 being excellent and 1 being poor. 5	5 being excellent and 1 being poor. 4	5 being excellent and 1 being poor. 3	5 being excellent and 1 being poor. 2	5 being excellent and 1 being poor. 1	5 being excellent and 1 being poor. N/A

7. Rate the courtesy you were shown by the staff of Great Land.

	5	4	3	2	1	N/A
5 being excellent and 1 being poor.	*Rate the courtesy you were shown by the staff of Great Land. 5 being excellent and 1 being poor. 5	5 being excellent and 1 being poor. 4	5 being excellent and 1 being poor. 3	5 being excellent and 1 being poor. 2	5 being excellent and 1 being poor. 1	5 being excellent and 1 being poor. N/A

8. Rate the cleanliness of the store.

	5	4	3	2	1	N/A
5 being excellent and 1 being poor.	*Rate the cleanliness of the store. 5 being excellent and 1 being poor. 5	5 being excellent and 1 being poor. 4	5 being excellent and 1 being poor. 3	5 being excellent and 1 being poor. 2	5 being excellent and 1 being poor. 1	5 being excellent and 1 being poor. N/A

9. The staff at Great Land Infusion Pharmacy did a good job protecting the privacy and confidentiality of my health care information.

The staff at Great Land Infusion Pharmacy did a good job protecting the privacy and confidentiality of my health care information. Strongly agree

Agree

Neutral

disagree

Strongly disagree

10. Overall, how would you rate you experience with Great Land Infusion Pharmacy?

Overall, how would you rate you experience with Great Land Infusion Pharmacy? Very positive experience

Somewhat positive experience

Neutral experience

Somewhat negative experience

Very negative experience

Copy of Patient Satisfaction Survey
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