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+1 (701) 551-6980 info@cpmfargo.com

Patient Satisfaction Survey

We are continuously striving to improve our services to make your pain management experience more satisfying. Please take a few moments to answer the following questions. Your answers will remain anonymous unless you choose to identify yourself. Thank you for participating.

    PATIENT SURVEY:

    Provider Name: (required)

    Your Name: (optional)

    Date of Service:

    PLEASE RATE THE FOLLOWING:

    Our receptionist is friendly and helpful:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    You can schedule a convenient / timely appointment with your healthcare provider:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    You usually wait less than 20 minutes to see your healthcare provider:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    Your healthcare provider is professional and courteous:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    Your healthcare provider listens to your concerns:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    Your healthcare provider answers all your questions:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    Your healthcare provider adequately explains any tests or treatment options:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    You usually receive your test results in a timely manner:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    You would refer a friend or family member to your healthcare provider:

      Strongly AgreeAgreeN/ADisagreeStrongly Disagree

    ADDITIONAL COMMENTS: