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In order to find out how
we are meeting your needs, we are asking our patients a few questions
about their satisfaction with the care they have received. Please be
candid in your answers. We plan to use your suggestions to make our
services to you and your family even better. Your participation is
appreciated.
Please Note:
If you have a serious
condition that needs immediate attention, please
contact your physician
or call 911. |
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The primary office I see my
physician at is:
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I was last treated:
Month
Year
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Please rate your overall experience with
the following departments. Your ratings can range from
"5 - Very
Satisfied"
to
"1 - Very
Dissatisfied"
or
"Not Applicable"
if you haven't had any interaction with that department.
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| Q1 |
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The Call Center
The
call center answers your phone call, schedules your appointment,
forwards calls appropriately.
● Friendly and efficient?
● Helpful and professional?
● Attentive listener? |
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| Q2 |
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Front Desk
Reception
The front desk reception greets you upon
arrival, collects your co-pay, assembles and updates your
demographics and insurance information.
●
Friendly and
courteous?
● Professional and efficient?
● Responsive and helpful? |
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| Q3 |
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X-Ray
Department
The x-ray
department transports you, takes pictures of your injured body
part, produces copies of x-rays upon request.
● Professional and friendly?
● Clear communication?
● Responsive to questions? |
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| Q4 |
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Physician
This ranking should take into account the thoroughness of
the examination, your satisfaction with the information you were
given about your condition, the way your questions were answered
and the treatment alternatives that were presented to you.
● Professional?
● Identified diagnosis?
● Timeliness?
● Clear treatment plan?
● Effective listener? |
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| Q5 |
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Back-Office Staff
The personnel who assist the physician with
your office visit, answers your questions and/or medical needs.
Medical Assistants and Cast Technicians.
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Professional and friendly?
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Responsive and attention to detail?
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Timeliness? |
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| Q6 |
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Surgery Scheduling
Personnel responsible for
coordinating all aspects of your surgical procedure, including
detailed insurance information.
Effective communication verbal and/or written.
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Responsive and informative?
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Timeliness?
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Friendly and professional?
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| Q7 |
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Patient Billing
Personnel who bills and/or assists you with your insurance
information and patient account.
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Professional and friendly?
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Attention to detail?
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Responsive? |
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| Q8 |
If there is anyway we can improve our
services to you, please let us know about it:
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| Q9 |
During your visit to MOS, if there was
someone who made your visit a pleasant experience, please let us
know their name or department.
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Please
review your answers before hitting "Submit".
(Some Mouse scroll wheels can
accidentally change "drop down" selections - please review your
answers)
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