Patients Survey

Your Name

Your Email

Phone Number

Please rate the following: 5 = Excellent     4 = Very Good     3 = Good/ Above Average     2 = Average     1= Below Average

1. How would you rate your overall satisfaction concerning your initial contact with our pharmacy & customer service specialists?

 
Were they courteous and helpful?
54321
 
Were they knowledgeable?
54321
 
Were they easy to contact?
54321

2. Please rate your experience(s) with our pharmacists and/or clinical staff in the following areas:

 
Was the pharmacist knowledgeable?
54321
 
Were they easy to contact?
54321
 
Were they courteous and helpful?
54321
 
Did the pharmacist address all of your concerns?
54321
3. If you needed copay assistance did Elwyn Specialty Care explain the appropriate programs available?
54321
4. Do you feel that there is enough communication between you and Elwyn Specialty Care?
54321
5. Are your prescriptions filled on time and delivered in a timely manner each month?      YesNo
 
If no, please explain:
6. Are your prescriptions accurately filled each month?     YesNo
 
If no, please explain:
7. Please rate the overall effectiveness of your interactions and consultations with your Elwyn Specialty Care representative.
54321
8. Please rate the level of education you received about your specific plan of care and medication therapy regimen.
54321
9. How would you rate your overall satisfaction with Elwyn Specialty Care?
54321
10. Were you given patient education materials about your medication and specific disease state?
YesNo
11. Would you like to be contacted by upper management to discuss any of your feedback and or suggestions?      YesNo
 
If yes...What phone number and time is best to utlilize
12. Please add any additional comments or suggestions on ways that we may improve our level of service.