Patient Satisfaction Survey
 

Patient Satisfaction Survey

Dear Patient:

We always strive to deliver the best possible care and service to our patients. Please help us to improve our sleep study services by completing this survey about your experience with us. After you have completed this form, please click SUBMIT to send the form.

Patient Name:(optional)
Patient Email:(optional)
Date of Care:
Location of Care:

The Scheduling Encounter
Did the scheduler introduce himself/herself to you? Yes      No
Was the scheduler helpful and polite? Yes      No
Did the scheduler explain the care you were going to receive? Yes      No
Did the scheduler explain your financial responsibilities to you fully? Yes      No
Did the scheduler answer all of your questions to your satisfaction? Yes      No

The Clinical Encounter
Did the caregiver introduce himself/herself to you? Yes      No
Was the caregiver and polite? Yes      No
Did the caregiver go over paperwork with you? Yes      No
Did the caregiver explain the care you were going to receive? Yes      No
Did the caregiver put you at ease before you went to sleep? Yes      No
Was the caregiver attentive to your needs during the night? Yes      No

The Physical Encounter
Was your room clean? Yes      No
Was the bed comfortable? Yes      No
Was the room temperature comfortable? Yes      No
 
Please explain any "No" answers or other comments:
 
Would You Like To Hear Back From Us? Yes      No
 

 

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1341 Ochsner Blvd     Covington, LA 70433


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