General Public Satisfaction Survey-WEB

1. Satisfaction Survey

Question Title

1. When you called, how did you get the IPC's telephone number? (Required.)

Internet

Directory assistance (e.g. 411)

Physician's office

Local Hospital

Pharmacy

911

Poison Center materials (sticker, magnet, etc)

Advice line (e.g. Ask-a-nurse)

Friend or family member

Media (radio/TV/newspaper)

Phone Book

Other, please specify

Question Title

2. Was the poison center staff member who answered your call polite? (Required.)

Yes

Comments

Question Title

3. Were the instructions given by the poison center staff clear? (Required.)

Yes

Comments

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4. Were the instructions given by the poison center staff easy to follow? (Required.)

Yes

Comments

Question Title

5. Did the Poison Center staff member offer you the following information? (Required.)

	Yes	No
Signs and symptoms to watch for	Signs and symptoms to watch for Yes	Signs and symptoms to watch for No
Time frame to watch for signs/symptoms	Time frame to watch for signs/symptoms Yes	Time frame to watch for signs/symptoms No
Advice on what to give or do for the patient	Advice on what to give or do for the patient Yes	Advice on what to give or do for the patient No
Follow-up call schedule	Follow-up call schedule Yes	Follow-up call schedule No
I was instructed to go to the emergency department	I was instructed to go to the emergency department Yes	I was instructed to go to the emergency department No

Comments

Question Title

6. How would you rate the overall service provided by the IPC? (Required.)

Excellent

Good

Fair

Poor

Comments

Question Title

7. Would you call the Illinois Poison Center again for a poisoning? (Required.)

Yes

Comments

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8. What would you have done if you were not able to contact a poison center? (Required.)

Call 911

Call the doctor

Call the emergency room

Visit the emergency room

Visit an urgent care center

Call nurse help line

Search the internet for information

Wait and see

Other (please specify)

Question Title

9. When you called, were you offered a complimentary packet of poison prevention information including IPC stickers and magnets? (If not, please click here to request one: http://illinoispoisoncenter.org/Request_a_Complimentary_Packet)

Yes

Question Title

10. What type of insurance does the caller have?

Private/Commercial (e.g. Blue Cross Blue Shield, Aetna, etc)

Medicare

Medicaid

Uninsured/self-pay

Would rather not answer

Other (please specify)

Question Title

* 1. When you called, how did you get the IPC's telephone number? (Required.)

Question Title

* 2. Was the poison center staff member who answered your call polite? (Required.)

Question Title

* 3. Were the instructions given by the poison center staff clear? (Required.)

Question Title

* 4. Were the instructions given by the poison center staff easy to follow? (Required.)

Question Title

* 5. Did the Poison Center staff member offer you the following information? (Required.)

Question Title

* 6. How would you rate the overall service provided by the IPC? (Required.)

Question Title

* 7. Would you call the Illinois Poison Center again for a poisoning? (Required.)

Question Title

* 8. What would you have done if you were not able to contact a poison center? (Required.)

Question Title

* 9. When you called, were you offered a complimentary packet of poison prevention information including IPC stickers and magnets? (If not, please click here to request one: http://illinoispoisoncenter.org/Request_a_Complimentary_Packet)

Question Title

* 10. What type of insurance does the caller have?

1. When you called, how did you get the IPC's telephone number? (Required.)

2. Was the poison center staff member who answered your call polite? (Required.)

3. Were the instructions given by the poison center staff clear? (Required.)

4. Were the instructions given by the poison center staff easy to follow? (Required.)

5. Did the Poison Center staff member offer you the following information? (Required.)

6. How would you rate the overall service provided by the IPC? (Required.)

7. Would you call the Illinois Poison Center again for a poisoning? (Required.)

8. What would you have done if you were not able to contact a poison center? (Required.)

9. When you called, were you offered a complimentary packet of poison prevention information including IPC stickers and magnets? (If not, please click here to request one: http://illinoispoisoncenter.org/Request_a_Complimentary_Packet)

10. What type of insurance does the caller have?