Illinois Poison Center

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Illinois Poison Center - Web Satisfaction Survey

Please enter the following information for our recording purposes (all information will remain confidential):

City Zip Code

1. When you called, how did you get the IPC’s telephone number?

Phone book
Directory assistance (i.e., operator, 411, etc.)
911
Local hospital
Physician's office
Pharmacy
Advice Line
Poison center materials (sticker, magnet, brochure)
Friend or family member
Internet (IPC Web site, other poison-related Web site)
Media (radio/TV/newspaper)

Other: please list source

2. Did the poison center staff answer your call right away?

Yes
No

Please feel free to explain:

3. Was the poison center staff polite?

Yes
No

Please feel free to explain:

4. How would you rate your overall experience with the poison center staff who answered your call?

Excellent
Good
Fair
Poor

Please feel free to explain:

5. Why did you call the IPC?

Emergency:for treatment recommendation following a potential poisoning
Information: information regarding potential poisons
Education: regarding events/presentations
Material request: order educational materials

If you called during an emergency, continue on to question #6.

If you called for information, education or materials, skip to questions #8.

If you called during an emergency:

6. Were the instructions given by the poison center staff clear?

Yes
No

If you called during an emergency:

7. Were the instructions given by the poison center staff easy to follow?

Yes
No

8. Did poison center staff offer you the following information? (Check all that apply)

Signs and symptoms to watch for
Time frame to watch for signs/symptoms
Follow-up call schedule
Packet of education information
I was instructed to go to the emergency department

9. How would you rate the overall service provided by the IPC?

Excellent
Good
Fair
Poor

Please feel free to explain:

10. Would you call the Illinois Poison Center again for a poisoning problem or question?

Yes
No

Please feel free to explain:

11. What would you have done if you were not able to contact a Poison Center?

12. What is your main reason for visiting the IPC Web site today? Choose one

For poison prevention information
For information about poisonings
For general information about the IPC
To obtain contact information for the IPC
To order poison prevention materials

Other: please list

13. Did you find what you were looking for on the site?

Yes
No

If no, what did you need/want?

14. What would you like to see added to or changed about the Web site?