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Patient Satisfaction Survey

Home Patient Satisfaction Survey

HOMELINK appreciates being able to serve you as a patient. Please fill in the answers to the questions below. Those marked with an * are mandatory fields.


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Did you have contact with a HOMELINK representative during the process of receiving equipment or services? If so, please complete the survey below. If not, please skip ahead to "Other Comments".
Please rate the HOMELINK contact:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) Did you receive all of your equipment/supplies/Pharmacy product/orthotic or prosthetic device?
    • 1) Did you receive all of your equipment/supplies/Pharmacy product/orthotic or prosthetic device?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) How timely did you receive your equipment?
    • 2) How timely did you receive your equipment?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) Was your item delivered by a local medical equipment company?
    • 3) Was your item delivered by a local medical equipment company?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) How detailed was the instruction given from the technician?
    • 4) How detailed was the instruction given from the technician?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) How likely are you to recommend this company?
    • 5) How likely are you to recommend this company?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  6. 6) How does the equipment or supplies meet your expectations?
    • 6) How does the equipment or supplies meet your expectations?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

Click the answer that best describes the service that you received:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) How would you rate your overall experience at our imaging center?
    • 1) How would you rate your overall experience at our imaging center?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) How timely was your appointment scheduled?
    • 2) How timely was your appointment scheduled?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) How satisfied were you with the exam preparation instructions?
    • 3) How satisfied were you with the exam preparation instructions?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) How reasonable was your wait time?
    • 4) How reasonable was your wait time?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) How clean and well cared for was the facility?
    • 5) How clean and well cared for was the facility?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  6. 6) How friendly and helpful was the technician that performed the scan?
    • 6) How friendly and helpful was the technician that performed the scan?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  7. 7) How detailed were the instructions given from the technician before and during the scanning?
    • 7) How detailed were the instructions given from the technician before and during the scanning?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

Click the answer that best describes the service that you received:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) Did you receive home care?
    • 1) Did you receive home care?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) How timely were the services provided?
    • 2) How timely were the services provided?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) Rate your comfort level with the care you received.
    • 3) Rate your comfort level with the care you received.
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) How professional and courteous was the person delivering the care?
    • 4) How professional and courteous was the person delivering the care?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) How informative were your care instructions?
    • 5) How informative were your care instructions?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  6. 6) How likely are you to recommend this company?
    • 6) How likely are you to recommend this company?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

Click the answer that best describes the service that you received:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) Was the evaluation scheduled in a timely manner?
    • 1) Was the evaluation scheduled in a timely manner?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) Were appointments scheduled at a convenient time?
    • 2) Were appointments scheduled at a convenient time?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) How professional and courteous were the staff members?
    • 3) How professional and courteous were the staff members?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) How professional and courteous was the person delivering the care?
    • 4) How professional and courteous was the person delivering the care?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) How was the overall care you received?
    • 5) How was the overall care you received?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  6. 6) How likely are you to recommend this company?
    • 6) How likely are you to recommend this company?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

Click the answer that best describes the service that you received:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) How would you rate your transportation services overall?
    • 1) How would you rate your transportation services overall?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) How timely were the services?
    • 2) How timely were the services?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) How safe did you feel on your trip?
    • 3) How safe did you feel on your trip?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) How professional and courteous was the driver?
    • 4) How professional and courteous was the driver?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) How likely are you to recommend this company?
    • 5) How likely are you to recommend this company?
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

Did you have contact with a HOMELINK representative during the process of receiving equipment or services? If so, please complete the survey below. If not, please skip ahead to "Other Comments".
Please rate the HOMELINK contact:

    • RATING:
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  1. 1) Professional, Knowledgeable
    • 1) Professional, Knowledgeable
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  2. 2) Prompt follow through
    • 2) Prompt follow through
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  3. 3) Courteous
    • 3) Courteous
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  4. 4) Clear Communication
    • 4) Clear Communication
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  5. 5) Trustworthy
    • 5) Trustworthy
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional
  6. 6) Fully attentive to your needs
    • 6) Fully attentive to your needs
    • Poor
    • Average
    • Fair
    • Good
    • Exceptional

  • Thank you for taking the time to let us know how we can improve our service. Your feedback is important to us!

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