Regional Access Specialist Site Visit Survey/Feedback



  1. Regional Access Specialist Name:


  1. Physician Name:


  1. Sales Representative Name:


  1. Date of Site Visit:


  1. Please rate the professionalism of your Regional Access Specialist (RAS).
    Excellent
    Good
    Fair
    Poor


  1. Please provide any comments you may have to question 5.


  1. Please rate the knowledge of your RAS regarding the suite of services available to your office.
    Excellent
    Good
    Fair
    Poor


  1. Please provide any comments you may have to question 7.


  1. Did the RAS explain how the suite of services can benefit your patients currently on or considering therapy?
    Yes
    No


  1. Please provide any comments you may have to question 9.


  1. What information was most beneficial for your office?
    Support Card
    Support Services
    Reimbursement Services
    Face-to-Face Regional Access Specialist to Customer Interaction
    All of the Above


  1. Please provide any comments you may have to question 11.


  1. Would you recommend a Regional Access Specialist site visit to your colleagues for their patients on therapy?
    Yes
    No


  1. Please provide any comments you may have to question 13.


  1. Would you request an Regional Access Specialist site visit again in the future?
    Yes
    No


  1. Please provide any comments you may have to question 15.


  1. Do you have any recommendations for improving the RAS site visits?


  1. Do you have any other feedback you would like to share regarding your Regional Access Specialist site visit?




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