Patient Satisfaction Survey
It is our desire to provide you with the best quality services available. In order to help us maintain our high standards, please take a few moments to tell us how we are doing.
Full Name
*
Phone
*
Date of birth
*
Was your equipment (and supplies if applicable) delivered on time?
Yes
No
Was the equipment (and supplies if applicable) delivered / dispensed accurately?
Yes
No
Was the training and consultations effective in educating you or your caregiver on your equipment (and supplies if applicable)?
Yes
No
Were the educational materials and instructions provided adequate to educate you or your caregiver on the product(s) provided?
Yes
No
Was the pharmacy staff courteous and helpful?
Yes
No
Were your financial responsibilities explained to you?
Yes
No
Did you receive advice or help when requested?
Yes
No
Did the services provided have a positive impact on the outcome of your care?
Yes
No
Would you recommend our services to friends and family?
Yes
No
Did the services provided meet your needs and expectations?
Yes
No
Comments and Recommendation (Optiional)
