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1
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The initial teaching and education I received were clear and easy to understand.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
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2
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The teaching methods were helpful.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
|
| |
3
|
I was satisfied with the ongoing education, support and assistance I received.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
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| |
4
|
I received information about possible side effects caused by my medication(s).
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
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4
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5
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| |
5
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The medication information provided was informative and helpful.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
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| |
6
|
I was told who to call if I had problems with my therapy.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
|
| |
7
|
I was satisfied with the response I received if I called for assistance during evenings and weekends.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
|
| |
8
|
The delivery of my medications and/or supplies was convenient and on time.
| Strongly Disagree | | | | Strongly Agree |
1
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2
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3
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4
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5
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| |
9
|
The equipment I received was clean and in good working condition.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
|
4
|
5
|
| |
10
|
The amount of supplies delivered was adequate for my therapy.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
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4
|
5
|
| |
11
|
The staff was courteous and helpful.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
|
4
|
5
|
| |
12
|
I was satisfied with the knowledge level of the staff.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
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4
|
5
|
| |
13
|
The services provided met my needs and expectations.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
14
|
All my questions, problems, or concerns were answered completely and promptly.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
|
4
|
5
|
| |
15
|
The patient rights and responsibilities were adequately explained to me.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
16
|
I was pleased with the service I received from the
Pharmacist
| |
17
|
I was pleased with the service I received from the
Customer Service Coordinator
| |
18
|
I was pleased with the service I received from the
Reimbursement Specialist
| |
19
|
I was pleased with the service I received from the
Delivery Tech
| |
20
|
The billing and reimbursement assistance provided was helpful.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
21
|
My financial responsibilities for this service were adequately explained to me.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
22
|
I would recommend Maxor Specialty to my friends and family.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
23
|
I was told what to do if my services were interrupted due to weather or a natural disaster.
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
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4
|
5
|
| |
24
|
Do you feel your pain has been adequately controlled (if applicable)?
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
|
4
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5
|
| |
25
|
Do you feel your care with Maxor Specialty has been safe? Regarding medication, equipment, adequate education, etc.?
| Strongly Disagree | | | | Strongly Agree |
1
|
2
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3
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4
|
5
|
| |
26
|
Overall level of satisfaction with all care and services provided:
| Strongly Disagree | | | | Strongly Agree |
1
|
2
|
3
|
4
|
5
|
| |
27
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Please use the following space for additional comments.
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28
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Contact me about your pharmacy service.
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29
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Optional Contact Information
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