Physician Nurse Practitioner Mobile Service Experience Survey

Physician or Nurse Practitioner Mobile Services Experience Survey

Please take a few moments to provide insights about your experience with our mobile services. Shared information helps us to help others. We value your opinion and hope to collaborate with our partners in health for the best possible outcome in all cases. Please note, the information received is reviewed regularly as part of our quality assurance program. Thank you for sharing with us today.

Administrative and Clerical Services

How friendly and professional were the staff who helped you today?

Was the staff member you spoke with knowledgeable?

Were your questions answered/concerns addressed?

Images and Reports

Accuracy of reported findings:

Did you receive faxed reports when requested?

Were you contacted by phone to receive urgent medical findings?

Quality of images:

Quality of professional reporting:

Technical Services

Level of professionalism and knowledge of technical staff:

Technologist interactions with your patients and staff:

Did your patient provide any feedback about technical staff?

Overall Services

Communication with management team

Appointment wait/response time

Needs Assessment

Provision of Ultrasound

Provision of X-ray

Please comment:

Comments or Other Suggestions

Overall, how would you rate our mobile services?

For mobile diagnostic services, what do you feel is an acceptable wait time for:

1. Routine ultrasound exams:

2. Routine x-ray exams:

3. Urgent ultrasound exams:

4. Urgent x-ray exams:

What is most important to you regarding diagnostic services?

Is there anything we can do to improve our mobile services?

If you would like to discuss with our management team, please select:

Yes No

Contact information

If you answered yes to having our management team reach out to discuss your form with you, please provide us with your contact information below

Name:

Designation:

Healthcare Facility Name or Private Office:

Best Daytime Phone Number:

* Email: This field is required to receive our confirmation email after submitting this form.

Date of Service:

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Survey - Mobile

Physician or Nurse Practitioner Mobile Services Experience Survey