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Mission Palliative Care Survey
We always care about your experience. Please help us improve our services by completing this brief survey. It takes about 3 minutes to finish and is anonymous unless you share your contact information.
1.
I receive the help I want for pain and/or other symptoms.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
2.
I feel heard and understood by my team.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
3.
My team helps improve my quality of life.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
4.
My team helps me know what to expect about my health and prepare for the future.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
5.
Receiving this care helps me avoid medical complications and/or unwanted hospitalization.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
6.
My team does an excellent job coordinating with my doctor(s) and other healthcare providers.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
7.
My team helps me connect with community resources.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
8.
FOR CAREGIVERS:
Because of my team, I feel less stress or strain caring for my loved one.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
9.
On a scale of 1-5, how would you rate our care?
Poor
1 star
Fair
2 stars
Good
3 stars
Very Good
4 stars
Excellent
5 stars
10.
I would recommend Mission to my friends and family.
Strongly agree
Agree
Somewhat Agree
Disagree
Strongly Disagree
11.
Please share additional comments or suggestions below. If you would like to speak with us, please include your name and phone number.