You Talk, We’ll Listen
Complete this survey and you could win a $50 gift card from Oley!

                                                                   Not                                                        Most
                                                               Important                                                Important

1. Staff Managing Your Requests             1           2          3           4           5     

2. Medical Director Consultations             1           2          3           4           5       

 3. The LifelineLetter                              1           2          3           4           5   

 4. Web site: www.oley.org                      1           2          3           4          5     

5. Annual Summer Conference                 1           2          3           4          5   

6. Regional Conferences                          1           2          3           4           5 

7. Consumer Toll-free Phone Calls           1           2          3           4           5

 8. Regional Coordinator Efforts               1           2          3           4           5 

9. Support Group Meetings                      1           2          3           4           5

 10. Equipment Exchange Program           1           2          3           4           5

 11. Tools for Better Living:

Keep Me Safe poster and bracelet     1           2          3           4           5

HPN complication chart                     1           2          3           4           5

HEN complication chart                     1           2          3           4           5

Restaurant card                                  1           2          3           4           5

Travel/Hospitalization packet              1           2          3           4           5

  Any ideas for future programs or newsletter topics?

 Other comments?

 Fast Facts From You

Name:

Address:

City:                State:               Zip:

 Phone

 E-mail

 Send me the newsletter via e-mail for faster service.

 Date of birth (month/year) 

Sex  Male  Female

 Diagnosis

 Began HomePEN therapy (month/year)

 What therapy are you on? (Check all that apply.)

     HPN (IV fed)        HEN (tube fed)                  Hydration       Presently off therapy

Catheter type (IV feeders)

 Tube type G-tube  J-tube  Button  Other

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Questions? Contact us at (800) 776-OLEY or bishopj@mail.amc.edu