USA Doctors On Wheels – Visiting Physicians in Richardson, Texas - Customer Satisfactory Survey

March 3, 2019 469-453-1423 doctors@usadow.com

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Customer

Satisfactory Survey

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In the pursuit of service excellence, we would like to get your comments/suggestions on the USA Doctors on Wheels services. Please take time to evaluate our 4 - STEP survey. Thank you.

Name
Optional
Email*
Date
Time

: HH

MM
Type of Respondent*

What service you want to survey?*
- Clinical Care Support Services
- Schedulers' Services
- Medical Assistants
- Medical Records Services
Select what service you want to survey.

Clinical Care Support Services
1. Needs are addressed accordingly*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
2. Statements given were easy to understand*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
3. Concerns are resolved within 24 hours*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
4. Facilitated patients’ medication refills*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
5. The staff are courteous and approachable*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree

Schedulers' Services
1. Statements given were easy to understand*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
2. Informed patient/SPA of any changes in the scheduled home visit*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
3. Complaints are resolved within 24 hours*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
4. The staff are courteous and approachable*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree

Medical Assistants
1. Introduced name and explained the Consent forms clearly with the doctor*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
2. Arrived on-time on scheduled visit*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
3. Informed patient/SPA of any delay in visit or cancellation of visit*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
4. Called patient/SPA at least 20 minutes prior to arrival at patient’s home*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
5. The staff are courteous and approachable*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree

Medical Records Services
1. Processes for requesting medical records are clear and concise*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
2. Medical records request released in a timely manner*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
3. Concerns are resolved within 24 hours*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree
4. The staff are courteous and approachable*
- Strongly Agree
- Agree
- Disagree
- Strongly Disagree

As a whole, are you satisfied with the services provided/received?*
- Yes
- No
Are you going to refer USA Doctors on Wheels to others?*
- Yes
- No
Comments/Suggestions:*
Phone
This field is for validation purposes and should be left unchanged.

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USA Doctors on Wheels

Contact Info

375 Municipal Drive, Suite 218 Richardson, TX 75080
469-453-1423
469-453-1436
doctors@usadow.com

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CUSTOMER SATISFACTION SURVEY