PATIENT SATISFACTION SURVEY

Please honestly rate the 10 questions below by percentage. For example; 100% is completely satisfied, 50% is half satisfied, 0% is not satisfied at all and N/A if the question does not apply.

1) How would you rate AST's response to any questions, problems, concerns, and/or comments you brought to their attention?

2) How would you rate AST's delivery of items or services (scheduled time VS actual delivery time?

3) How would you rate AST's ability to correctly bill your insurance provider(s)?

4) How would you rate AST's ability in respecting your personal dignity and your cultural, social, and spiritual values?

5) How would you rate AST's ability to protect the privacy and security of your personal health information?

6) How would you rate AST's ability to assess and identify your needs?

7) How would you rate AST's willingness to include you, your family members, and/or your caregivers in the decisions about your care, treatments, and/or services?

8) How would you rate the information and educational materials AST provided you regarding the care, treatment, and/or services provided?

9) How would you rate AST's entry in your residence as it pertains to respecting your property?

10) How would you rate the overall satisfaction with the products and/or services provided to you by AST?

Comments, questions or suggestions?

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Thank you for participating in our study. The information you have provided will never be used for sales purposes but only for providing better service to you and other customers like you.

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