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Date
*
Month
/
Day
/
Year
ACCESS - Eleos staff treated me with respect.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
Eleos staff explained the program to me when I was admitted.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
I could contact Eleos staff easily.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
EFFECTIVENESS - Eleos staff worked with me to schedule timely appointments.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
I felt comfortable discussing my treatment preferences with the ARNP.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
The ARNP answered any/all questions I had pertaining to my treatment recommendations, and prescribed medications if applicable.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
EFFICIENCY - I feel that the services provided to me have met, or are meeting my needs, and have improved my overall quality of life.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
The on-site pharmacy provided me with adequate education on the medications prescribed to me, and answered any/all questions about my prescriptions.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
The on-site pharmacy filled my prescriptions within 30 minutes.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
OVERALL SATISFACTION - I feel that I have benefited from the services provided from this program.
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
Overall, I am satisfied with the services Eleos has provided.
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Not applicable
How many times have you met with your ARPN before completing this survey?
1
2-5
6-10
11-15
More than 15
Additional Comments / How could we better serve you?
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