Name of Person Completing the Survey(Optional)

First NameLast Name

Email (Optional)

Clinic/Facility Name (Optional)

Date

Ashley GilbowKevin NunnallyMisty Ruhl CRTTBrandon Meredith

YesNo

Each year, as part of Medical Solutions of Arkansas continued accreditation we are required to reach out to our referral partners in the form of a satisfaction survey. This survey is vital to our performance improvement efforts and your participation is greatly appreciated.*

Rows	YES	NO
When calling the office Medical Solutions staff is helpful, courteous, prompt & professional.
Our delivery staff delivers equipment ordered in a timely professional manner.
The quality, variety and availability of products we carry are adequate for your patient needs.
Would you recommend our services to friends, family, and colleagues?
The representative that visits your clinic meets or exceeds your expectations for patient care, service and professionalism.

For MD's - APRN's - APN,s

Rows	YES	NO
Ordering process meets your expectations?
Would your clinic send more orders if there were additional electronic (digital) options?

Please advise whether your office utilizes any additional or alternative methods to transmit orders for medical equipment to other suppliers that we may not be aware of such as other digital platforms. We want to earn all of your business.*

What can MedSol do to earn more of your business? (Optional)

DID YOU KNOW?

According to Google
Research indicates that nearly 550,000 individuals each year over the age of 65 need medical attention due to injuries sustained during bathroom falls. As per CDC reports, around 80% of all bathroom accidents involve falls, with the majority occurring near or in the shower/tub area or near toilets. Nov 9, 2023

According to Arkansas Department of Health

Falls are the leading cause of injury death in adults ages 65 and older. The number of fall injuries and deaths is expected to increase as the Baby Boomer Cohort ages; the number of seniors 65 and older will increase from 40 million to more than 88 million in 2050.

Medical Solutions of Arkansas offers an array of bathroom equipment to keep our seniors safe. Clients with Full Range Arkansas Medicaid & a medical need qualify for these services. Clients with congestive heart failure, shortness of breath, dizziness, unsteady on their feet, repeated falls, and more will qualify.

All we need to get started is the prescription.

We recommend:

Tub grab bar for stability when entering/exiting the tub/shower &
Shower chair or tub transfer bench to remain seated while bathing &
Hand held shower to control the direction and flow of water while remaining safely seated.

At delivery the driver will determine if the bathroom can accommodate the shower chair OR tub transfer bench.

Survey Signature (Optional)

Confidentiality: If you wish to speak to the office manager, feel free to call the office at 1-870-910-0400 or email Michelle@medsol.net

All conversations are kept private and confidential.

Physician's Click here to download: Electronic Physican Order Form

Referral Facilities Click here to download: Electronic Referral Request Form

Physician / Referral Satisfaction Survey

DID YOU KNOW?