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Patient Satisfaction Survey

Thank you for taking our short survey - we value your input!
1.Location Code (located on the survey postcard):(Required.)
2.Status:(Required.)
3.I was satisfied with the overall quality of the services provided.(Required.)
4.I would recommend this pharmacy to my family and friends.(Required.)
5.The medications and supplies arrived before I needed them.
6.My deliveries contained the right medications and supplies.
7.I knew who to call if I needed help with my therapy.
8.The response I received to phone calls for help on weekends or during evening hours met my needs.
9.The nurse or pharmacist informed me of the possible side effects of the medication.
10.I understood the explanation of my financial responsibilities for the therapy.
11.Rate how often each staff were courteous.
Always
Very Often
Sometimes
Rarely
Never
N/A
Delivery Staff
Billing Staff
Pharmacy Staff
Nursing Staff
12.Rate how often each staff were helpful.
Always
Very Often
Sometimes
Rarely
Never
N/A
Delivery Staff
Billing Staff
Pharmacy Staff
Nursing Staff
13.I understood the instructions provided for:
Yes
No
N/A
How to wash my hands
How to give medication(s)
How to care for the IV catheter
How to store medication(s)
How to use the home infusion pump
14.The pump was clean when it was delivered.
15.The pump worked properly.
A Note Regarding Your Protected Health Information: Please be advised that this web page may not meet all encryption requirements for the protection of health information. Therefore, please do not enter any information about your social security, treatment, diagnosis, or financial information of any kind. If you would like the pharmacy manager to contact you to discuss the services you received you may provide your name and phone number or email address. However, we cannot guarantee the privacy of the information.
16.Comments:
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