doctor-checkup

Patient Feedback

From administrators to nurses, physicians to delivery personnel, at MIT we are committed to offering increasing levels of exceptional patient care. Your input and feedback are extremely valuable in helping us emphasize our strengths and focus on areas of improvement. Please take a moment to provide us feedback on your MIT experience below and thank you for choosing us for your outpatient care.

Recently, you received services from our company. We would appreciate your evaluation and comments regarding the services and products you have received from Medical Infusion Technologies. Please complete this survey and hit submit so that we may review your comments and feedback. Please an answer for each of the questions below according to the specific service(s) you received.

1. Strongly Agree
2. Mostly Agree
3. Neither Agree nor Disagree
4. Mostly Disagree
5. Disagree
Not Applicable

1. The medications(s) and/or supplies were delivered on time.
 1 2 3 4 5 Not Applicable

2. The equipment was clean when delivered.
 1 2 3 4 5 Not Applicable

3. The equipment remained in good working order.
 1 2 3 4 5 Not Applicable

4. The instructions were adequate for safe use of the equipment.
 1 2 3 4 5 Not Applicable

5. The instructions were adequate to teach me and/or my caregiver how to give the infusion medication.
 1 2 3 4 5 Not Applicable

6. My pain was adequately controlled most of the time (if applicable).
 1 2 3 4 5 Not Applicable

7. The staff was courteous and helpful.
 1 2 3 4 5 Not Applicable

8. I was told who to call if I had problems with my infusion medications(s).
 1 2 3 4 5 Not Applicable

9. I had the supplies I needed to take my infusion medications on time.
 1 2 3 4 5 Not Applicable

10. I was satisfied with the response I received if I called for assistance on weekends or during evening hours.
 1 2 3 4 5 Not Applicable

11. I would recommend your service to my friends and family.
 1 2 3 4 5 Not Applicable

12. The services provided met my needs and expectations.
 1 2 3 4 5 Not Applicable

13. Patient Rights and Responsibilities were adequately explained to me.
 Yes No

14. My financial responsibilities for the services and/or equipment provided were adequately explained to me.
 Yes No

15. I received information about possible side effects caused by my infusion medications.
 Yes No

16. I was told what to do if my services were interrupted due to the weather or a natural disaster.
 Yes No

17. I received instructions on how to wash my hands and handle my supplies in order to prevent infection.
 Yes No

18. Additional Comments:

Name

Email

I am the (check one):
 Patient Family Member Caregiver