Thank you for taking the Indiana Poison Center web-based survey. Please answer the questions below to the best of your abilities. If there are questions you would prefer not to answer, feel free to skip them. Your feedback is very important to IPC and we look forward to learning what we do well and what we can improve upon. If you have a poisoning emergency or a question for IPC please call 1-800-222-1222. 

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* 1. Your Contact Information

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* 2. Who did you call the poison center for?

For the following demographic questions, please answer about the person for which you called the poison center. This person is now referred to as the patient.

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* 3. What is the patient's age range?

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* 4. With which race does the patient identify?

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* 5. With which gender does the patient identify?

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* 6. Please answer the following questions using these ratings:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Your call was answered promptly.
The IPC staff member you spoke with was friendly and courteous.
The IPC staff member gave your useful information.
Your case was handled in a timely fashion.
The instructions you received today were easy to understand.

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* 7. How did you find the telephone number for the Poison Center?

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* 8. What would you have done if the poison center was not available?

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* 9. What type of insurance do you have for the patient?

  Private State Medical Assistance No/Unk Coverage
Type of Insurance

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* 10. Would you call the Indiana Poison Center again for a poisoning problem or question?

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* 11. Would you recommend calling the Indiana Poison Center to other people?

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* 12.  Do you have any additional comments?

Thank you for your time. Please call the Indiana Poison Center if we can help you in the future.

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