Satisfaction Survey

Please take a minute to complete our Healthcare
Provider Satisfaction Survey

Your satisfaction with our services is very important to us, and your feedback

will help ensure we’re providing your patients the highest standard of patient care.

First Name*

Last Name*

CPSO/CNO/Member Number*

Email*

1. Are you satisfied with the way the appointments are arranged?*

Yes No

2. Are your phone calls attended to promptly and courteously?*

Yes No

3. Is the requisition easy to follow?*

Yes No

4. Are the reports concise and comprehensive?*

Yes No

5. Are the reports received in a timely manner?*

Yes No

6. Do you find our locations and office hours to be convenient?*

Yes No

7. Overall, have we met or exceeded your expectations?*

Yes No

8. Would you recommend Lawrence Park Cardiology to a colleague?*

Yes No

9. How likely will you continue referring your patients to Lawrence Park Cardiology?*

Most Likely Possibly Unsure Not Likely

10. Which EMR do you work with?*

Most Likely Possibly Unsure Not Likely

11. How did you refer your patient(s) to us?*

Referral Pad EMR Fax Email Ocean eReferral

12. How did you hear about Lawrence Park Cardiology? (Select all that apply)*

Driving or Walking By Email Fax Google Search Letter Other Healthcare Provider Patient Representative from Lawrence Park Cardiology Requisition Form Social Media

Additional Comments or Suggestions on How We Can Improve:

Permission to Use as a Promotional Material

I give Lawrence Park Cardiology permission to post my comments on promotional materials. By submitting this form, I agree to receive periodic E-mails about your free CME webinars, and the latest information about your services. I can unsubscribe at any time.

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Please take a minute to complete our Healthcare Provider Satisfaction Survey

Please take a minute to complete our Healthcare
Provider Satisfaction Survey