Thank you allowing AMC Case Managers to assist with your work injury.  We value your input as a measure of our company’s effectiveness and ask that you take a few moments to complete the following questionnaire to enable us to better serve injured workers similar to yourself.


Timeliness of case manager contact:

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* 1. Timeliness of case manager contact:

Case Manager explanation of CM services:

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* 2. Case Manager explanation of CM services:

Availability and accessibility of case manager by phone, email or text:

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* 3. Availability and accessibility of case manager by phone, email or text:

Case managers assistance in explaining the injury, treatment and medications:

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* 4. Case managers assistance in explaining the injury, treatment and medications:

Effectiveness of the case manager in resolution of injury:

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* 5. Effectiveness of the case manager in resolution of injury:

Rate your involvement in decision making pertaining to your injury:

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* 6. Rate your involvement in decision making pertaining to your injury:

Were you satisfied with the outcome of your case management services?

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* 7. Were you satisfied with the outcome of your case management services?

Additional Comments

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* 8. Additional Comments

Case Manager Name

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* 9. Case Manager Name

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