Your Satisfaction with our services is very important to us. Please complete this short survey and return it to us. Your input will help us continue to improve.
Strongly Agree-5, Mostly Agree-4, Neither Agree/Disagree-3, Mostly Disagree-2, Disagree-1
The medication and/or supplies were delivered on time.  
1 2 3 4 5  
The equipment was clean when delivered.  
1 2 3 4 5  
The equipment has remained in good working order.  
1 2 3 4 5  
The instructions were adequate to teach me or my caregiver how to give the intravenous (IV) medications.
1 2 3 4 5  
The staff was courteous and helpful.
1 2 3 4 5  
I was told who to call if I had a problem with my intravenous (IV) medications.  
1 2 3 4 5
I had the supplies I needed to take my intravenous (IV) medications on time.  
1 2 3 4 5
I was satisfied with the response I received if I called for assistance on weekends or during evening hours.  
1 2 3 4 5
I would recommend your services to my friends and family.
1 2 3 4 5
The services provided met my needs and expectations.
1 2 3 4 5
Patient rights and responsibilities were adequately explained to me.
1 2 3 4 5
My financial responsibilities for the services and/or equpment were adequately explained to me.
1 2 3 4 5
I received information about possible side-effects caused by my intravenous (IV) medications.
1 2 3 4 5
I was told what to do if my services were interrupted due to the weather or a natural disaster.  
1 2 3 4 5
 
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