Patient Survey

Patient Survey

Patient Survey

Homedica House Calls
We value your feedback. This short survey helps us improve the care and services we provide. Your responses are confidential. Thank you for being part of the Homedica House Calls community.
What is the name of your Homedica provider?

In the last 6 months, how often did this provider...

Rows	Never	Sometimes	Usually	Always
Explain things in a way that was easy to understand
Listen carefully to you
Show respect for what you had to say
Spend enough time with you

In the last 6 months, how often did you get an appointment as soon as you needed?
How easy was it to reach your provider or care team by phone or telehealth when you had a question?

In the last 6 months, how often did your provider or care team…

Rows	Never	Sometimes	Usually	Always
Follow up with you about test results or treatments
Know important information about your medical history
Help you manage your medications
Talk with other providers about your care

In the last 6 months, how often did your provider or care team…

Rows	Never	Sometimes	Usually	Always
Ask if you had a treatment choice you preferred
Include your family/caregivers in decisions when you wanted
Treat you with courtesy and respect

Using a number from 0 to 10, where 0 is the worst and 10 is the best, how would you rate your Homedica provider?

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9

10

1 is Worst, 10 is Best
How likely are you to recommend Homedica to family or friends?
In the last 6 months, did anyone from Homedica talk with you about…
Is there anything else you’d like us to know about your care experience?
Should be Empty: