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Patient Survey

Your opinion is extremely important and we will use it to improve the quality of our care.

Please take a few minutes to fill out this survey.
Items marked with * require a response.
- The staff explained how they obtained your medication order*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff explained financial responsibility, insurance coverage , insurance benefit and cost*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff included the Notice of Privacy information*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff explained your care plan*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff discussed your shipping and how to order refills*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff was courteous over the phone*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The medication was delivered in time*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff was easy to reach if you called with a question*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The response you received when you called for assistance on weekends or after hours was satisfactory*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff assisted you with complaints or problems*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- Adequate information about how to store your medication was supplied*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- Adequate information about possible side effects was supplied*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- Adequate information about emergency preparedness was supplied*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- Adequate information about how to dispose medications and sharps was supplied*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- The staff was respectful and courteous in your home*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- You felt comfortable administrating the medication*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- You are satisfied with the overall quality of information and care you are receiving*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
- You are likely to recommend our services*
  - Strongly Agree
  - Agree
  - Neutral
  - Disagree
  - N/A
Please share any additional comments, concerns or suggestions to help us improve care and patient safety.
Is there a particular staff member you would like to mention? Why?
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