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NELC Patient Satisfaction Survey
1.
Please rate how often NELC staff were helpful and courteous.
Always
Very Often
Sometimes
Rarely
Never
Comments:
2.
I understood the instructions provided for:
Yes
No
N/A
How to wash my hands
Yes
No
N/A
How to give the home infusion medication(s)
Yes
No
N/A
How to care for the IV catheter
Yes
No
N/A
How to store the home infusion medication(s)
Yes
No
N/A
How to use the home infusion pump
Yes
No
N/A
Comments:
3.
I was satisfied with the overall quality of the services provided.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Comments:
4.
I would recommend New England Life Care to my family and friends.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Comments:
5.
I understood the explanation of my financial responsibilities for home infusion/enteral therapy.
Yes
No
Comments:
6.
Providing the following information is optional
Name
Email Address
Phone Number
Insurance Provider
7.
Would you like someone to contact you regarding your response to this survey?
Yes
No
8.
Are you willing to answer a few more questions?
Yes
No
