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The InfuCare Rx Partner Satisfaction Survey
Do not include any patient identifying information in your responses.
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1.
Respondent Type:
(Required.)
Prescriber (Physician, Practitioner, or Physician Assistant)
Other (please specify)
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2.
The name of the facility or practice you represent:
(Required.)
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3.
Care Planning: How satisfied are you with the process and ease of starting your patient on service with InfuCare Rx?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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4.
Delivery: How satisfied are you with the timeliness and accuracy of the delivery of products and services?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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5.
Quality: How satisfied are you with the safety, quality of care, products, and information delivered by InfuCare Rx?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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6.
Staff Responsiveness: How satisfied are you with the courteous and timely responsiveness of our staff to your inquiries?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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7.
Staff Knowledge: How would you rate our staff's knowledge regarding services we provide?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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8.
Pharmacy Services: How satisfied are you with the clinical pharmacy services provided?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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9.
Nursing Services: How satisfied are you with the nursing care provided to your patients?
(Required.)
1 - Very satisfied
2 - Somewhat satisfied
3 - Neutral or N/A
4 - Somewhat dissatisfied
5 - Very dissatisfied
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10.
Communication: How would you rate the politeness, helpfulness, and ease of contacting staff members at InfuCare Rx?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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11.
Complaint Resolution: How satisfied are you with the timely and comprehensive manner for which your concerns were investigated and resolved?
(Required.)
5 - Very satisfied
4 - Somewhat satisfied
3 - Neutral or N/A
2 - Somewhat dissatisfied
1 - Very dissatisfied
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12.
Satisfaction: How likely are you to recommend InfuCare Rx to others?
(Required.)
4 - Very likely
3 - Somewhat likely
2 - Neutral or N/A
1 - Not likely
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13.
Do you have any other comments, questions, or suggestions regarding how we can improve our service to you?
(Required.)
14.
Feedback is important to us and your input will help us better serve you. Are you interested in further communication regarding your survey responses?
Yes
No
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15.
Please provide your name and practice information.
(Required.)
Prescriber Name
Contact Name
