Survey Date (mm/dd/yyyy):    

Client Name:                          

Telephone Number:               

Contact Name:                       

Case Management

Interaction with AOMS personnel:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Access to preferred provider consultants or organizations:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Effective and timely return to work for injured/ill employees:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS Disability Management service:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS fitness documentation and reporting formats:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Physician On-Call Services

Access and communication with on-call physicians:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Friendly response and clear, decisive direction from on-call physicians:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

On-call service appropriate/knowledgeable to meet your needs:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Follow-up with patient outcome after medevac/casevac:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Procurement

Timely response to procurement requests:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Procurement item(s) accurate and appropriate when received:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Contact with procurement personnel generally satisfactory:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Procurement personnel knowledgeable regarding your issues and requests:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Procurement process and documentation trail accurate and satisfactory:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Experience with AOMS Personnel

AOMS personnel understanding your needs:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

The level of technical expertise, experience of AOMS personnel:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS responsiveness to inquiries:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS personnel courteousness:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS personnel professionalism:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Range of AOMS services available:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Reliability of service from AOMS:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Offshore Personnel

AOMS services comprehensive, accessible and meeting your needs:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS offshore personnel respond satisfactorily and timely:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Complex case resolution conducted satisfactorily and timely:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

On-call shore-based physician service:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

Medevac team response timely and adequate:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied

AOMS meets your needs in worker health issues on a day to day basis:
Extremely Satisfied       Somewhat Satisfied    Neutral
Somewhat Dissatisfied  Extremely Dissatisfied