What Do You Need From Your Medical Providers?
1.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
I prefer not to answer
2.
What is your gender?
Female
Male
Nonbinary
I prefer not to answer
3.
What language(s) do you prefer to communicate in?
Arabic
Armenian
Chinese (Cantonese)
Chinese (Mandarin)
English
French
German
Greek
Italian
Japanese
Korean
Russian
Spanish
Tagalog
Vietnamese
Other (please specify)
4.
How do you prefer to receive communications from SuperCare Health?
Email
Postal mail
Phone call
Text/SMS messaging
Other (please specify)
5.
Choose all the devices you use regularly to communicate with other people, organizations, or companies.
Mac (desktop or laptop)
Windows (desktop or laptop)
Apple smartphone
Android smartphone
Standard phone
Apple tablet
Android tablet
Other (please specify)
6.
What equipment has SuperCare Health provided to you? (Choose all that apply)
Oxygen (tanks, concentrator, portable concentrator)
Ventilator (invasive, non-invasive)
CPAP / BiPAP device and supplies
Airway clearance device or vest
Nebulizer and nebulized medication
Pediatric care and supplies
Urological and incontinence supplies
Home medical equipment (walkers, beds, wheelchairs, etc.)
Other (please specify)
7.
When you interact with our staff, how well do we address your specific condition, situation, and questions?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
8.
Any additional comments about our interactions?
9.
How well did we educate you on your condition, your equipment and supplies, and what you can expect from following your treatment plan?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
10.
Any additional comments about our educational efforts?
11.
If you have accessed the resources available to you on the Patient Solutions section of our website, how would you rate their usefulness to you?
Very useful
Somewhat useful
They are fine to have, but I didn't use them
I tried to use them but they we're only slightly helpful
They failed to help me at all
N/A - Didn't visit the website or use any online resources
12.
Any additional comments about our online resources?
13.
Overall, how well do you feel SuperCare Health has supported you in managing your condition?
Completely supported
Mostly supported
Somewhat supported
Not well supported
Not supported at all
14.
Any additional comments about our support?
15.
Overall, how would you rate the quality of your experience with SuperCare Health?
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
16.
Any additional comments about your overall experience?
17.
On a scale of 0 to 10,
How likely is it that you would recommend this company to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
18.
What improvements, changes or additions would you suggest to enable SuperCare Health to better meet your needs?
