+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: