* 1. On a scale of 5 to 1, where 5 = strongly agree and 1 = strongly disagree, how would you rate our services?

  Strongly Disagree Disagree Neutral Agree Strongly Agree
The initial teaching and education I received were clear and easy to understand.
The teaching methods were helpful.
I was satisfied with the ongoing education, support and assistance I received.
I received information about possible side effects caused by my medications.
The medication information provided was informative and helpful.
I was told who to call if I had problems with my therapy.
The delivery of my medications and/or supplies was convenient and on time.
The equipment I received was clean and in good working condition.
The amount of supplies delivered was adequate for my therapy.
The staff was courteous and helpful.
I was satisfied with the knowledge level of the staff.
The services provided met my needs and expectations.
All my questions, problems, or concerns were answered completely and promptly.
The patient rights and responsibilities were adequately explained to me.
The billing and reimbursement assistance provided was helpful.
My financial responsibilities for this service were adequately explained to me.
I would recommend Maxor Specialty to my friends and family.
I was told what to do if my services were interrupted due to weather or a natural disaster.
Do you feel your pain has been adequately controlled if applicable?
Do you feel your care with our organization has been safe? Regarding medication, equipment, adequate education, etc.?
Overall level of satisfaction with all care and services provided.

* 2. was please with the service I received from:

  Yes No N/A
Customer Service Coordinator
Reimbursement Specialist

* 3. Please use the following space for additional comments.

* 4. Contact you about our pharmacy service?

* 5. Contact Info