The Back Center - Back Authority for Contemporary Knowledge

Welcome to our Website

Back Authority for
Contemporary Knowledge

The B.A.C.K. Center Now Offers
Adult Stem Cell Procedures

The Back Center - Back Authority for Contemporary Knowledge
The Back Center - Back Authority for Contemporary Knowledge  
For Patients

Take Our Surveys

Provider Satisfaction Survey

Name :
Date :
Your Physician and/or Non-Physician Practitioner's name(s):
Email :
1) Is this your first visit, or a return visit?
2) Why did you choose this office for your medical treatment?
Near my office or home
Referred by another patient
Telephone listing
Website (www.thebackcenter.net)
Referred by another physician)
Picked from my insurance plan physician listing
Other

3) How long did it take you to get in for your initial appointment?
days

weeks
4) Please describe your initial telephone call:
The telephone was answered promptly
I was put on hold
The line was busy
Comments

5) Please rate the person who answered your call:
Please circle one
Discourteous   »   1      2      3      4      5 «   Courteous
6) How were you treated when you arrived at the reception desk?:
Please circle one
Unpleasant   »   1      2      3      4      5 «   Pleasant
7) After you arrived, how long did you have to wait to see your physician or non-physician practitioner? minutes
Please circle one
Unsatisfactory   »   1      2      3      4      5 «   Satisfactory
8) Please rate the nurse/medical assistant?
Please circle one
Disinterested   »   1      2      3      4      5 «   Personable
9) How was the attitude of the office staff?
Please circle one
Cold   »   1      2      3      4      5 «   Friendly
10) Were you satisfied with the amount of time the doctor spent with you?
Please circle one
Very Dissatisfied   »   1      2      3      4      5 «   Very Satisfied
11) Please rate the physician's interest in your problem.
Please circle one
Indifferent   »   1      2      3      4      5 «   Interested
12) How would you assess your doctor's explanation of your illness and treatment?
Please circle one
Inadequate   »   1      2      3      4      5 «   Excellent
13) Were you satisfied with the medical treatment you received?
Please circle one
Very Dissatisfied   »   1      2      3      4      5 «   Very Satisfied
14) Would you like someone to contact you personally about any of your questions or concerns?
Yes No (If yes, please leave your name and telephone number below)
Comments
  
Devin K. Datta, MD
Richard A. Hynes, MD, FACS
Susan Ville
S. Farhan Zaidi, MD
Lawrence A. Zeff
Steven G. Ortiz
Anne C. Gregg, PA-C
Casey W. Langel, PA-C
Damian Velez, MPAS, PA-C
Jeanette ‘Jan’ Gluck, PA-C
Amanda A. Folkers, PA-C
Latest News
Read More »
Conditions Procedures
Patient Forms
Prescription Refill
Multimedia Patient education
Stem Cells Advocate
Radio Show
© The Back Center Back Pain Spine Surgery Melbourne Florida
Home | Disclaimer | Privacy | Sitemap | Feedback | Tell a friend | Contact Us
Your Practice Online The Back Center - Back Authority for Contemporary Knowledge For Appointments Call: (321) 723 7716