Medication Access Program (MAP) Patient Survey

Please read each of the statements carefully and circle the number that describes your opinion. We welcome your comments and are interested in what you have to say so that we may improve the program. Thank you very much for your time and effort in completing this survey.

MAP Patient ID# ^*
The MAP staff is courteous. ^*
The MAP staff seems interested in helping me obtain my prescription medication. ^*
The questions that I asked the MAP staff were answered in a timely manner. ^*
The MAP staff shows concern for me. ^*
The MAP staff is helpful. ^*
The MAP staff behaves in a professional manner. ^*
The MAP has made it easier for me to get my prescription medications. ^*
The MAP has saved me money by helping me obtain prescription medications. ^*
My medication problems have decreased since being enrolled in MAP. ^*
The MAP is a useful program. ^*
Please list other prescription medications that you are taking that you want the MAP to try to assist you with.
Please provide additional comments in order for the MAP to better serve you.
* Required