Caller Satisfaction Survey

1. How did you know to call Poison Control Center?

	Container said to contact a Poison Control Center.
	Told to call a Poison Control Center by Doctor or ER.
	Told to Call Poison Control Center by company or manufacturer.
	Read information from internet to call Poison Control Center.
	I have used Poison Control Center in the past.
	Other:

2. Where did you find the number to call the Poison Control Center?

	Family, friend, neighbor
	Internet
	Brochure, magnet, phone sticker
	911
	Emergency room
	Doctor, Doctor's office
	Insurance company
	Container label
	Other:

3. If the Poison Control Center was not available to you what would you have done?

	Call 911
	Call the emergency room
	Go to the emergency room
	Call doctor's office
	Go to doctor's office
	Call family or friend for advice
	Stay home
	Other:

5. Did the Poison Control Center Staff member(s) you spoke with use words that you understood?

	Yes
	No Please Explain:

6. Was the Poison Control Center staff member(s) knowledgeable?

	Yes
	No Please Explain:

7. Did the Poison Control Staff member(s) give you instructions you could follow?

	Yes
	No Please explain:

8. Was the Poison Control Center staff member(s) you spoke with courteous and friendly?

	Yes
	No Please Explain:

9. Is there a Poison Control Staff member(s) you would like to recognize for a job well done?

	No
	Yes Staff member(s) name:

10. Do you feel the Poison Control Center answered all your questions?

	Yes
	No Please Explain:

11. Would you use our service again?

	Yes
	No Please Explain:

12. Would you recommend our service to friends or family members?

	Yes
	No Please Explain

*13. Would you be willing to be contacted by our Public Relations Department to share your experience for a news story if needed?

	No
	Name and Phone number

14. Please feel free to leave us any additional comments, concerns or feedback: