Patient Satisfaction Survey Questions

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AMS Coumadin Clinic – Patient Survey

Thank you for choosing the AMS Coumadin Clinic at Athens Regional Medical Center. We take pride in continuously improving our care.

This survey is anonymous, we do not know who filled out this questionnaire. We appreciate your honest feedback.

All of the time Some of the time Please rate the following questions based on this scale:

The clerical staff/secretary is courteous and helpful.

I can get an appointment that works with my schedule.

The amount of time I wait for my appointments is acceptable.

The Pharmacists are professional and concerned about my Coumadin therapy and my health.

The Pharmacist takes enough time with me during my visit.

The Pharmacist/clinic returns my phone calls in an acceptable time frame.

My personal information is kept private.

1 2 3 4

None of the time

5 NA

I receive clear instructions on how to take my Coumadin from the Pharmacist.

Please rate how comfortable you are with the information given to you by the Pharmacists:

Reason (indication) I take Coumadin

Side effects of Coumadin

Clear & understandable

1 2

Somewhat unclear

3 4

Do not understand

5

Did not receive information

What to do if I miss a dose

Vitamin k (greens) in my diet and how it works with Coumadin

Importance of calling clinic with medication changes

How long have you been a patient in the clinic?

What do you like best about the clinic?

0-3 months 3-6 months >6 months

What can we do to improve the clinic and the care you receive?

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