Texoma Neurology Associates Patient Survey

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1. Please enter:

	MM		DD		YYYY
Your Appointment Date	Please enter: Your Appointment Date Month	/	Day	/	Year

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2. What office location did you visit?

What office location did you visit? Sherman, TX

Denison, TX

McKinney, TX

Durant, OK

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3. What provider did you see?

What provider did you see? Easwar Sundaram, Jr, MD

Bharathy Sundaram, MD

Jose Matus, MD

Jerome Lopez, MD

Mohamad Al-Rifai, MD

Bonnie Smithers, NP

Tien Ho, PA

Jodie Moore, NP

Colin Hill, PA

MRI Tech

EEG Tech

Infusion Nurse

4. On a scale of 1 to 5, please answer the following:

	Poor	Below Average	Average	Above Average	Excellent
How was your experience with our scheduling process and staff?	*On a scale of 1 to 5, please answer the following: How was your experience with our scheduling process and staff? Poor	How was your experience with our scheduling process and staff? Below Average	How was your experience with our scheduling process and staff? Average	How was your experience with our scheduling process and staff? Above Average	How was your experience with our scheduling process and staff? Excellent
Were you greeted warmly and professionally when you arrived for your appointment?	Were you greeted warmly and professionally when you arrived for your appointment? Poor	Were you greeted warmly and professionally when you arrived for your appointment? Below Average	Were you greeted warmly and professionally when you arrived for your appointment? Average	Were you greeted warmly and professionally when you arrived for your appointment? Above Average	Were you greeted warmly and professionally when you arrived for your appointment? Excellent
Did the provider thoroughly answer all your questions during your visit?	Did the provider thoroughly answer all your questions during your visit? Poor	Did the provider thoroughly answer all your questions during your visit? Below Average	Did the provider thoroughly answer all your questions during your visit? Average	Did the provider thoroughly answer all your questions during your visit? Above Average	Did the provider thoroughly answer all your questions during your visit? Excellent
How was your experience with our check-out process and staff?	How was your experience with our check-out process and staff? Poor	How was your experience with our check-out process and staff? Below Average	How was your experience with our check-out process and staff? Average	How was your experience with our check-out process and staff? Above Average	How was your experience with our check-out process and staff? Excellent
How would you rate the cleanliness of our office?	How would you rate the cleanliness of our office? Poor	How would you rate the cleanliness of our office? Below Average	How would you rate the cleanliness of our office? Average	How would you rate the cleanliness of our office? Above Average	How would you rate the cleanliness of our office? Excellent
How would you rate your overall experience with our office?	How would you rate your overall experience with our office? Poor	How would you rate your overall experience with our office? Below Average	How would you rate your overall experience with our office? Average	How would you rate your overall experience with our office? Above Average	How would you rate your overall experience with our office? Excellent

Additional Comments:

5. How likely are you to refer a family member or friend to our office?

How likely are you to refer a family member or friend to our office? Yes, definitely!

Maybe.

No, definitely not!

Additional Comments:

6. We always like to recognize those employees who go above and beyond to give great service to our patients. Is there someone in our office who we might recognize?

We always like to recognize those employees who go above and beyond to give great service to our patients. Is there someone in our office who we might recognize?

7. Are there any suggestions or final comments that you would like us to know?

Are there any suggestions or final comments that you would like us to know?

8. Would you be willing to share your contact information with us?

Would you be willing to share your contact information with us? Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

Thank you for taking the time to complete this survey. We value your feedback, and take it very seriously, as it helps us continue to improve our service to our patients.

Texoma Neurology Associates Patient SurveyExit this survey

1.

*1. Please enter:

*2. What office location did you visit?

*3. What provider did you see?