Patient Satisfaction Survey

Patient Satisfaction Survey

Dear Patient, 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.

To complete this survey on a 1 to 5 scale, read each question carefully and select the number that best represents your opinion, where "1" signifies the lowest rating and "5" signifies the highest rating.

Carefluent Connect staff was courteous and helpful.*

1 - Strongly Disagree

2 - Disagree

3 - Neutral

4 - Agree

5 - Strongly Agree

1

2

3

4

5

Training, education materials, and consultations were effective in educating me or my caregiver.*

1 - Strongly Disagree

2 - Disagree

3 - Neutral

4 - Agree

5 - Strongly Agree

1

2

3

4

5

I would recommend Carefluent Connect services to friends and family.*

1 - Strongly Disagree

2 - Disagree

3 - Neutral

4 - Agree

5 - Strongly Agree

1

2

3

4

5

Comments (Optional)

Would you like our Carefluent Connect staff to contact you for additional follow-up?*

Yes

No

Name

Best Method of Contact

Email

Phone

Email Address

Phone Number

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