2022 Multidisciplinary Clinic Satisfaction Survey

The ALS Association Florida Chapter is interested in learning about your experience with the care and services you have received from the Chapter and the ALS Multidisciplinary Clinics in Florida. Your feedback is important to help us identify opportunities for improvement to serve you better. This short survey will take you approximately 5-10 minutes to complete. Thank you for participating in this survey!

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* 1. Please select which applies to you:

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* 2. Please select which applies to you:

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* 3. Please confirm the Clinic you attend.

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* 4. Please rate your level of satisfaction with the following experiences during your clinic visits within the last year.

  very satisfied satisfied neutral dissatisfied very dissatisfied
The process of scheduling clinic visits.
Response to concerns/questions made during your visit.
The courtesy and respect shown to you and your family by the staff.
Follow up after clinic visit (e.g. prescriptions, equipment orders, resources).
Clinic staff worked together to care for you.
Your overall satisfaction with your clinic visits.

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* 5. Please mark your level of agreement with the following statements about your clinic visits.

  strongly agree agree neutral disagree strongly disagree
The staff was knowledgeable about my condition and status during the visit.
The expectations I had about attending clinic were met.

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* 6. What do you like about your clinic visit experience?

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* 7. Please provide comments/suggestions to help improve your clinic visit experience.

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* 8. Please provide your name/email (optional):

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