Form cover

Page 1 of 3

Patient Satisfaction Survey - Ambulatory Infusion Center

Dear Patient,

Your feedback enables us to improve the quality of care and services we provide to patients. Please take a few moments to tell us how we are doing.

The pharmacy team explained and took time to review how to take my medication, what side effects to watch for, and what I should expect.

*

The pharmacy team explained and took time to review how to take my medication, what side effects to watch for, and what I should expect.

1

2

3

4

5

Strongly DisagreeStrongly Agree

I was informed of who to contact at Apex Infusion and how to reach them if I have any questions or concerns.

*

I was informed of who to contact at Apex Infusion and how to reach them if I have any questions or concerns.

1

2

3

4

5

Strongly DisagreeStrongly Agree

The pharmacy team explained my insurance benefits, costs, and responsibilities clearly and in a way that was easy to understand.

*

The pharmacy team explained my insurance benefits, costs, and responsibilities clearly and in a way that was easy to understand.

1

2

3

4

5

Strongly DisagreeStrongly Agree

The infusion center staff were courteous and professional. The ambulatory infusion center was clean and well-organized, which helped me feel relaxed and comfortable.

*

The infusion center staff were courteous and professional. The ambulatory infusion center was clean and well-organized, which helped me feel relaxed and comfortable.

1

2

3

4

5

Strongly DisagreeStrongly Agree

The nursing team explained the infusion process in a clear, easy‑to‑understand way. They made me feel well cared for.

*

The nursing team explained the infusion process in a clear, easy‑to‑understand way. They made me feel well cared for.

1

2

3

4

5

Strongly DisagreeStrongly Agree

Overall quality of Apex Infusion services for my therapy:

*

Overall quality of Apex Infusion services for my therapy:

1

2

3

4

5

PoorExcellent

I am likely to recommend Apex Infusion's pharmacy and infusion center services to others.

*

I am likely to recommend Apex Infusion's pharmacy and infusion center services to others.

1

2

3

4

5

Strongly DisagreeStrongly Agree

Any additional comments/suggestions/concerns?

Would you like to be contacted regarding your feedback?

Would you like to be contacted regarding your feedback?

Yes, I would like to receive a follow-up.