Customer Survey

Because feedback is very important to us, AmeriPharma appreciates the fact that you’re taking the time to complete this survey. We take your assessment seriously, and we use your feedback to provide a better service to our customers.
Please check the box that is most relevant to your experience with AmeriPharma.

Your Name (Optional)

Please rate the quality of your experience with Pharmacy staff.

1 ( Very unprofessional)

2

3

4

5 (Extremely Professional)

*Please rate the quality of your experience with the Pharmacist.

1 ( Not Helpful)

2

3

4

5 (Very Knowledgeable)

*Please rate the timeliness of deliveries and condition of your medications when you receive them.

1 ( Damaged)

2

3

4

5 (Always Intact)

*Please rate the amount of benefit you feel the Patient Management program adds to your therapy.

1 (No Benefit)

2

3

4

5 (Greatly Improved)

*Please rate the improvement to your quality of life you feel your therapy adds.

1 (No Improvement)

2

3

4

5 (Greatly Improved)

*Please rate how likely you would be to recommend AmeriPharma to your prescriber or other patients.

1 (Not Likely)

2

3

4

5 (Extremely Likely)

Please provide any additional comments.

*Would you like to rate our nursing staff?

Yes

No or Not Applicable

The nurse takes time to answer my questions/concerns.

1 (Never)

2

3

4

5 (Always)

The nurse is courteous and professional.

1 (Never)

2

3

4

5 (Always)

The nurse is on time consistently.

1 (Never)

2

3

4

5 (Always)

The nurse coordinates in advance about future infusion appointments.

1 (Never)

2

3

4

5 (Always)

Please rate your overall satisfaction with your Nurse and Nursing services.

1 (Not Satisfied)

2

3

4

5 (Extremely Satisfied)

Please provide any additional comments.

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