AleraCare

Patient Satisfaction Survey

Patient Satisfaction Survey

Loaction(Required)

Name

AleraCare strives to offer you the best experience and deliver the best care possible to you. We value your opinion and request your feedback regarding your most recent clinic visit.

Provider Satisfaction(Required)

	Very Good	Good	Fair	Poor	Very Poor	N/A
How would you rate the professionalism of AleraCare’s staff?
How respectful was your Healthcare Provider?
How well did your Healthcare Provider address questions about your medication and health?
How well did your Healthcare Provider listen to you during your appointment?
How well did your Healthcare Provider insert your IV (if applicable)?
How easy was it for you to schedule your next appointment during your clinic visit?

Facility Satisfaction(Required)

AleraCare also wants to ensure your experience outside of our clinics and with our Patient Support Team are exceptional. Please provide feedback based on interactions via phone with AleraCare’s Patient Support Team.

Ease of Use(Required)

	Very Good	Good	Fair	Poor	Very Poor	N/A
How easy is it to get in touch with us by phone?
How easy was it to schedule an appointment?
How well did AleraCare work with your doctor to get you the medicine you needed?

Accuracy(Required)

Professionalism(Required)

Patient Comments(Required)

What does AleraCare do best?

What do you think that AleraCare could do better?

How likely is it that you would recommend AleraCare to a friend or colleague?(Required)

We appreciate your feedback and look forward to learning more about your experience.

Phone

This field is for validation purposes and should be left unchanged.

How convenient was it for you to go to this specific location for your treatment?

How clean and clutter free was the facility?

How professional was the appearance of the facility?

How comfortable was the facility (infusion chairs, amenities, etc.)?