EMP Medical Services, Inc. We make it our business to care. Home Health Care Management

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Patient Survey

Your Opinion is very important to us!

Please help us serve you and others better by completing our Patient Satisfaction Survey. Answering the questions below should only take a few minutes. Your participation is completely voluntary and will help us ensure that we are putting our customers first. If you have questions about how we will use this information, please review our Privacy Notice.

Last Name:
First Name:
D.O.B.:
Phone:
Was your equipment delivered timely and as expected?	Yes No

In your opinion, was the equipment clean and of good quality?	Yes No

Did your receive clear and understandable instructions, regarding the correct, safe use and care of equipment?	Yes No

Was delivery staff courteous, helpful and knowledgeable on equipment?	Yes No

If oxygen was delivered, do you understand the proper functioning, setting, and maintenance requirements of equipment?	Yes No

Were you informed that EMP services are available 24 hours a day, 7 days a week and that qualified personnel are ready to respond to emergencies, answer questions, troubleshoot and fill urgent orders?	Yes No

Were you satisfied with the overall quality or services?	Yes No

Would you recommend EMP to family or friends?	Yes No

Comments:

Name of care giver:

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