1. Thank you for choosing Boulder Neurosurgical & Spine Associates

 
The quality of your care is of great importance to BNA. To help us continually improve our services, please take a moment to provide us with your feedback.

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* 1. How would you rate your overall service experience with our practice?

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* 2. Please rate the following (scale of 1 to 5, with 5 being the best):

  5 4 3 2 1 N/A
Phone manners of general office staff
Phone manners of our surgeons, PAs and nurses
Ability to schedule a visit within your desired time frame
Convenience of your appointment time
Greeting upon arrival
Appropriate wait time at office visit
Courtesy and attentiveness of doctor
Courtesy and attentiveness of PA
Courtesy and attentiveness of other staff
Explanations provided/questions answered

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* 3. Did the doctor spend enough time with you?

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* 4. Did the PA spend enough time with you?

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* 5. Do you feel positive enough about our practice to refer family and friends?

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* 6. How did you hear about BNA. Check all that apply.

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* 7. Who referred you to our practice?

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* 8. Who did you see today?

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* 9. Please comment/provide suggestions regarding anything we can improve to enhance your experience with BNA.

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* 10. Did any staff members go out of their way to make your visit more pleasant or comfortable? If so, will you provide us with their name(s) so that we may acknowledge them?

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* 11. Your name (optional):

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* 12. Please provide a written testimonial and complete the following section indicating your approval to publish this testimonial on our Website. We are also happy to publish your related photo. Please send your photo to kathyb@bnasurg.com.

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* 13. I approve for BNA to post my testimonial on the Website bnasurg.com with (check all that apply):

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* 14. Input your name and the date below as an electronic signature indicating approval to post your testimonial.

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