Dear EmpiCare Patient:

EmpiCare recently serviced you with a brace, splint or other durable medical equipment ordered by your physician. Please take a few moments to complete the following survey. Your comments are needed to evaluate our level of customer service. This will help to ensure that every patient will receive the best possible care. All data will be kept confidential.

* Required

Physician/clinic/store
* Name: 
* Address: 
 
* City: 
* State: 
* Zip: 
 
* Service Representative Name: 
 
* How were the services you received from EmpiCare overall? (Please check the appropriate space)
* Did the Service Representative identify themselves by name and title?
* Did the Service Representative give you his/her name and phone number?
* Did our Service Representative ask you to read and sign our Insurance Fact sheet?
* Did our Service Representative verify your current home address and current insurance?
* Did you receive the pink copy of the Insurance Fact Sheet?
* Did you receive the EmpiCare Educational Handout, Privacy Notice, Return Policy, and Red Cross Handout?
* Did the Service Representative explain to you that the "Patient Bill of Rights" and "Medicare Standards" were on the back of your pink copy of the Insurance Fact Sheet?
* Did the Service Representative answer any questions you had regarding the "Patient Bill of Rights" and Medicare Standards?
* Were you informed prior to receiving the product of any possible financial responsibilities?
* Did our employee treat you with courtesy and respect?
* Did our employee explain to you how you would benefit from the product being received and did they give you proper education on fitting, everyday use and cleaning?
Comments:
* Was our employee well prepared, organized, and knowledgeable?
* If applicable, was the Service Representative easy to contact for questions or concerns?
In a follow-up to the previous question, did we respond to you in a timely manner?
Do you feel that obtaining the product immediately at the physician's office was a good service?
Did you recieve the pink copy of the Insurance Fact Sheet?
Did you recieve the EmpiCare Educational Handout, Privacy Notice, Return Policy, and Red Cross Handout?
   
Please add any additional comments to help us service you or other patients better in the future:
Patient name (Optional):
E-mail Address (Optional):
 

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Patients and Durable Medical Equipment

Concern for patient quality of life is fundamental to our DME program approach. Trust EmpiCare to fulfill your needs for orthotic equipment, fittings, education and to meet insurance requirements.
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Contact EmpiCare

        11802 Brinley Avenue, Evergreen Park North, Louisville, KY 40243-1089         1-800-738-8045         empicare@empi.com

The EmpiCare Vision

To establish EmpiCare as the country's most trusted provider of therapeutic DME and orthotic solutions that help patients heal without pain and help customers solve problems and maximize their efficiencies.

Our Process

Through the EmpiCare collaborative, a proprietary customer satisfaction process, we combine expert knowledge with medical applications to gain the trust and confidence of our customers, and help them manage their outsourced services by providing state-of-the-art clinical support, physician and institutional solutions, including DME and orthotic programs.

Our DME Point-of-Difference

At EmpiCare, we are committed to our customers, their patients and our physicians' bottom-lines. We provide the most extensive programs in the industry, positioning us to be the outsource DME industry leader in hassle-free DME therapeutic solutions.

The Bottom-Line

EmpiCare means: Creative DME problem solvers and field tested therapeutic solutions specialists who are uniquely qualified to maintain the trust and confidence of our clients-and gain new ones-through the EmpiCare collaborative customer satisfaction process.

EmpiCare is: The place where clinicians, institutions, and healthcare groups that practice, administer and support outsourced DME patient services turn for the industry's most innovative, value-added and customer focused solutions that simplify therapeutic support services without sacrificing either provider oversight or patient quality of care.

ACHC Accredited EmpiCareSM is a subsidiary of Empi, Inc., A ReAble Company
© 2010 ReAble Therapeutics and its affiliates