Patient Satisfaction Survey – Cardiology Associates of North MS

Physician Availability *

Excellent

Good

Fair

Poor

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Appointment Scheduling Process *

Excellent

Good

Fair

Poor

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Did you experience problems with telephone communication? *

Yes

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Location of scheduled appointment? *

Tupelo

Starkville

Oxford

Columbus

Corinth

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How comfortable was the waiting area? *

Excellent

Good

Fair

Poor

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The courtesy of our reception and appointment staff? *

Excellent

Good

Fair

Poor

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The admission process allowed for confidential information to be collected in a manner that maintained my privacy? *

Excellent

Good

Fair

Poor

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The billing process and my financial responsibilities were explained to me in a satisfactory manner. *

Excellent

Good

Fair

Poor

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About Your Medical Care and Physician:

The timeliness of being seen at your appointed time. *

Excellent

Good

Fair

Poor

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The time spent with physician. *

Excellent

Good

Fair

Poor

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The courtesy of the physician *

Excellent

Good

Fair

Poor

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Appointment Physician *

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The courtesy of the nurses and other medical staff *

Excellent

Good

Fair

Poor

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Are you a new patient to this physician? *

Yes

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What treatment was recommended? *

Medication

Surgery

Other

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If other what was recommended? *

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About Yourself:

Age of patient? *

Under 18

18-34

35-49

50-65

65+

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How did you hear about Cardiology Associates of North Mississippi? *

Physician Referral

Family

Friend

Internet

Insurance

Other

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Would you recommend Cardiology Associates of North Mississippi to your family and friends? *

Yes

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About Us:

The facility is clean and promotes a safe environment. *

Excellent

Good

Fair

Poor

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Overall satisfaction with Cardiology Associates of North Mississippi *

Excellent

Good

Fair

Poor

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Additional Comments:

Contact Information: In order to make certain we meet your expectations now and in the future, we will gladly follow-up with any concerns you may have. In order to facilitate this, we ask that you let us know how to contact you. Please note: You are not required to furnish contact information in order to submit your feedback; however, we encourage you to do so, as we value your opinion and would appreciate the opportunity to converse with you personally.

Name *

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Phone Number *

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