Survey

Patient Satisfaction Survey
  • General Questions

  • Date Format: MM slash DD slash YYYY
  • Please answer the following questions on a scale of 1 to 5, 5 being the highest level of satisfaction.

    Staff

  • Anesthesia Tech

    (the person that helped you change your clothes and assisted the doctor)
  • Technologist

    (the person that took the x-ray and helped with your treatment)
  • Nurse

    (helped you in the Recovery Room after treatment and spoke to you on the phone)
  • Billing Office

  • Pain Management

  • After the Treatment

  • Privacy and Security

  • 1 = poor, 2 = unsatisfactory, 3 = satisfactory, 4 = good, 5 = excellent