COE Patient Survey

  • COE Patient Survey

  • Please tell us your opinion about the service you received from the Center of Excellence you corresponded with or visited.  Scores and comments will be shared with the center, but your personal information will remain confidential unless you indicate otherwise.

  • Remain Anonymous*
  • Are You*
  • Is Patient*
  • Patient's Age*

  • RATE YOUR COMMUNICATION WITH THE CENTER

  • Did you access the Center's website?*
  • Did you find relevant information?
  • Did you call the Center?*
  • Were you directed to the appropriate service?
  • Did you email the Center?*
  • Did you receive a response?

  • TELL US ABOUT YOUR VISIT WITH THE CENTER

    Please note: LD = Lymphatic Disease
  • Did the patient receive instructions regarding follow-up care?*
  • Did the patient receive advice on ways to manage their LD?*
  • Did the patient receive referrals to other LD professionals, if applicable?*
  • Was the patient given a LE&RN welcome packet?
  • Was the patient given information about the LE&RN Global Registry for LD?
  • Was the patient provided information about any LD patient education?
  • Was the patient provided information about any LD support groups?

  • YOUR OVERALL SATISFACTION WITH:

  • The Center*
  • Quality of the patient's medical care*
  • Would you recommend the Center to others?*
  • Would you be willing to serve on an Affiliate Board consisting of patients and Center staff dedicated to improving services?*

  • Thank you for completing the COE Patient Survey.  If you have any questions, please contact LE&RN.

    Lymphatic Education & Research Network
    154 W 14th St, 2nd Floor
    New York, NY  10011
    516-625-9675
    coe@lymphaticnetwork.org
    https://lymphaticnetwork.org/

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