Homecare Customer Satisfaction Survey

Directions: Complete all applicable questions and click the Submit Survey button. Thank you for your input and participation.

Tell us about the products and services provided to you by Patio Drugs. What products or services has Patio Drugs provided to you? (check all that apply) Intravenous Medications Medications in a care facility Medical Equipment Respiratory medications Respiratory therapist services     If you received medical equipment please specify what type of equipment you received.

Tell us about your initial contact with Patio Drugs. Were you contacted over the phone by a Patio Drugs representative prior to the initial visit to your home?  Yes  No If yes, what information did the Patio Drugs representative discuss with you? (check all that apply) The products and services to be provided by Patio Drugs as ordered by your physician. The estimated time of delivery. Your estimated financial obligation for the products and services to be provided.

Please indicate the extent to which you agree with the following statement. I was contacted by a Patio Drugs representative via the phone prior to my initial delivery or visit and was provided sufficient information about the products and services I was to receive.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree

Tell us about the Patio Drugs representative that came to your home. What Patio Drugs representative made the first delivery or visit to your home?  Service Technician     Respiratory Therapist Was the initial delivery or visit made on time (within the timeframe specified)?  Yes   No If no, how late was the initial delivery or visit?  less than 1 hour   1-2 hours   over 2 hours If you received medical equipment: Was the equipment set up in an acceptable location?    Yes   No Were you adequately instructed on the safe use of the equipment, including alarms, if any?    Yes   No What other information was provided to you upon the initial delivery or visit? Patient Rights and Responsibilities How to reach Patio Drugs after hours Proper storage of medications and supplies What you should to do in the event of an emergency Other Information:  If you received deliveries or services after the initial visit, are you satisfied with the consistency of care or services provided?    Yes   No

Please indicate the extent to which you agree with the following statement. Patio Drugs Service Technicians and / or Respiratory Therapists make deliveries or visits to my home on time and provide adequate instruction and support for any equipment or supplies that I have received.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree  Not Applicable

Tell us about calls you have made to Patio Drugs. I have spoken to the following people when contacting Patio Drugs. (check all that apply) Pharmacist Billing Representative Respiratory Therapist Service/Equipment Technician Customer Service Representative     Did the Patio Drugs representative effectively assist you?   Yes   No Was your issue resolved?   Yes   No

Please indicate the extent to which you agree with the following statement. Patio Drugs' staff are knowledgeable, courteous and helpful in responding to my requests and concerns.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree  Not Applicable

Tell us about any after hours contacts you have made with Patio Drugs. I have spoken to the following Patio Drugs representatives after hours. (check all that apply) Pharmacist Respiratory Therapist Equipment Technician When calling after hours, my call was picked up by the answering service promptly and my call was routed to the proper on call personnel?    Yes   No The on call personnel returned my call within the following time frame. within 15 minutes within 15-30 minutes greater than 30 minutes Did the on call personnel adequately handle my problem or concern?    Yes   No Did your call result in an after hours visit by Patio Drugs personnel?    Yes   No If yes, was the visit made in sufficient time to adequately manage your problem or concern?    Yes   No

Please indicate the extent to which you agree with the following statement. Calls made to Patio Drugs after hours were answered promptly and to my satisfaction.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree  Not Applicable

Thank you for completing this survey. Feel free to offer additional comments. I wish to be contacted by a Patio Drugs Representative

Name Email Address Telephone   If you are a family member/caregiver and wish to be contacted, please provide your information. Name Email Address Telephone

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