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HIMG Patient Satisfaction Survey
1
. Please let us know how you felt about the ease of making appointments by phone or online
Please let us know how you felt about the ease of making appointments by phone or online
Excellent
Very Good
Good
Fair
Poor
Not Applicable
2
. Was your appointment available to you in a reasonable amount of time?
Was your appointment available to you in a reasonable amount of time?
Excellent
Very Good
Good
Fair
Poor
3
. Please indicate if you are a:
Please indicate if you are a:
New patient (first visit)
Established HIMG patient
4
. How would you rate the professionalism and courtesy of the registration clerk who checked you in for your visit?
How would you rate the professionalism and courtesy of the registration clerk who checked you in for your visit?
Excellent
Very Good
Good
Fair
Poor
Not Applicable
5
. How would you rate the professionalism and courtesy of the nurse(s) you dealt with on your visit?
How would you rate the professionalism and courtesy of the nurse(s) you dealt with on your visit?
Excellent
Very Good
Good
Fair
Poor
6
. How well do you feel your provider addressed your concerns during your visit?
How well do you feel your provider addressed your concerns during your visit?
Excellent
Very Good
Good
Fair
Poor
7
. Please let us know about your provider. Who did you see for your visit?
Provider One
Provider Two (if applicable)
Provider:
Ahmed Abdelgaber, MD
Michael Adkins, PA
Ronald Barebo, MD
Jama Barker, PA
William R. Beam, MD
Arvinder Bir, MD
Ron Brownfield, DO
Ashley Cantley, NP
Gregory Carico, MD
Denise Chambers, PA
R. Steven Childers, MD
Shawn Coffman, MD
Michael Collins, DO
Jeremy Cuzzort, MD
Thomas Dannals, MD
William Dennison, MD
Kerri Donahue, MD
John Eastone, MD
Anna Gibson, NP
James Goetz, MD
Skuli Gunnlaugsson, MD
Ron Haberman, MD
Laurie Harper, MD
Brian Heaberlin, MD
Jackie Jackson, NP
Tucker Jennings, MD
Joseph Justice, DO
Jeff Kaplan, NP
Gerrit Kimmey, MD
Suresh Kumar, MD
Todd Lester, PA
Myron Lewis, MD
George Linsenmeyer, MD
Karen Lo, DPM
Joseph LoCascio III, MD
Sally Lowe, NP
Daniel Macias, MD
Richard Mailloux, MD
Sandra Marshall, MD
Laura Mayer, NP
Kirt Miller, DPM
James Morgan III, MD
Marilyn Otto, MD
David Patick, MD
Dev Rellan, MD
Tim Robarts, MD
Jerrol Robinson, NP
Matthew Rohrbach, MD
Stephen Sebert, MD
David Smith, MA
Stephen Smith, MD
Daniel Snavely, MD
C. Dewayne Tackett, MD
Terrence Triplett, MD
Charles Turner, MD
Robert Turner, MD
Philip Veres, DO
William Weiss, MD
Please let us know about your provider. Who did you see for your visit? Provider: Provider One
Ahmed Abdelgaber, MD
Michael Adkins, PA
Ronald Barebo, MD
Jama Barker, PA
William R. Beam, MD
Arvinder Bir, MD
Ron Brownfield, DO
Ashley Cantley, NP
Gregory Carico, MD
Denise Chambers, PA
R. Steven Childers, MD
Shawn Coffman, MD
Michael Collins, DO
Jeremy Cuzzort, MD
Thomas Dannals, MD
William Dennison, MD
Kerri Donahue, MD
John Eastone, MD
Anna Gibson, NP
James Goetz, MD
Skuli Gunnlaugsson, MD
Ron Haberman, MD
Laurie Harper, MD
Brian Heaberlin, MD
Jackie Jackson, NP
Tucker Jennings, MD
Joseph Justice, DO
Jeff Kaplan, NP
Gerrit Kimmey, MD
Suresh Kumar, MD
Todd Lester, PA
Myron Lewis, MD
George Linsenmeyer, MD
Karen Lo, DPM
Joseph LoCascio III, MD
Sally Lowe, NP
Daniel Macias, MD
Richard Mailloux, MD
Sandra Marshall, MD
Laura Mayer, NP
Kirt Miller, DPM
James Morgan III, MD
Marilyn Otto, MD
David Patick, MD
Dev Rellan, MD
Tim Robarts, MD
Jerrol Robinson, NP
Matthew Rohrbach, MD
Stephen Sebert, MD
David Smith, MA
Stephen Smith, MD
Daniel Snavely, MD
C. Dewayne Tackett, MD
Terrence Triplett, MD
Charles Turner, MD
Robert Turner, MD
Philip Veres, DO
William Weiss, MD
Provider Two (if applicable)
8
. How would you rate your experience with any follow-up you received from HIMG?
How would you rate your experience with any follow-up you received from HIMG?
Excellent
Very Good
Good
Fair
Poor
Not Applicable
9
. How would you rate your experience with our phone system?
How would you rate your experience with our phone system?
Excellent
Very Good
Good
Fair
Poor
Not Applicable
10
. How pleased are you with the billing process at HIMG?
How pleased are you with the billing process at HIMG?
Excellent
Very Good
Good
Fair
Poor
11
. What suggestions do you have that we can use to improve your experience with us at HIMG?
What suggestions do you have that we can use to improve your experience with us at HIMG?
12
. If you used any ancillary services at HIMG during your visit, how would you rate your experience?
Lab
X-Ray
Physical Therapy
CT
MRI
Endoscopy
Excellent
*
If you used any ancillary services at HIMG during your visit, how would you rate your experience? Excellent Lab
Excellent X-Ray
Excellent Physical Therapy
Excellent CT
Excellent MRI
Excellent Endoscopy
Very Good
Very Good Lab
Very Good X-Ray
Very Good Physical Therapy
Very Good CT
Very Good MRI
Very Good Endoscopy
Good
Good Lab
Good X-Ray
Good Physical Therapy
Good CT
Good MRI
Good Endoscopy
Fair
Fair Lab
Fair X-Ray
Fair Physical Therapy
Fair CT
Fair MRI
Fair Endoscopy
Poor
Poor Lab
Poor X-Ray
Poor Physical Therapy
Poor CT
Poor MRI
Poor Endoscopy
Not Applicable
Not Applicable Lab
Not Applicable X-Ray
Not Applicable Physical Therapy
Not Applicable CT
Not Applicable MRI
Not Applicable Endoscopy
13
. If you wish, you are welcome to provide us with contact information:
If you wish, you are welcome to provide us with contact information:
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
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