Patient Satisfaction Survey
Your satisfaction is important to us. Let us know how we did with the delivery of the home infusion prescription medications and equipment provided to you by completing our Patient Satisfaction Survey. NOTE: This survey is not for the nursing home care provided.
This is not required.
Optional, your responses will be emailed to you.
YesNoI did not use a home infusion pump
YesNoI did not use a home infusion pump
AlwaysVery OftenSometimesRarelyNever
YesNo
AlwaysVery OftenSometimesRarelyNeverI did not need to call for help on weekends or during evening hours
YesNo
YesNo
AlwaysVery OftenSometimesRarelyNeverNot Applicable
Delivery Staff
Billing Staff
Pharmacy Staff
Nursing Staff
AlwaysVery OftenSometimesRarelyNeverNot Applicable
Delivery Staff
Billing Staff
Pharmacy Staff
Nursing Staff
YesNoNot Applicable
How to wash my hands
How to give the home infusion medication(s)
How to care for the IV catheter
How to store the home infusion medication(s)
How to use the home infusion pump
Strongly AgreeAgreeUncertainDisagreeStrongly Disagree
Strongly AgreeAgreeUncertainDisagreeStrongly Disagree