SurveyMonkey Powered Online Survey

YOUR EXAMINATION AND OVERALL EXPERIENCE WITH MCN

Medical Consultants Network thanks you for your time in taking this survey. We are interested in feedback regarding your experience of MCN's service.

Your participation today is completely voluntary and you can stop taking the survey at any point. Please note that your response is for quality control purposes only, and feedback may be used to improve our Policies and Procedures. The independent medical examiner who conducted your examination does not and will not have access to any survey responses.

Your completed survey responses will be encoded and will remain confidential. If you have questions at any time about the survey, you may contact MCN at one of our regional operations offices or by email at the email address listed below.

Thank you very much for your time and thoughts. You may start the survey now by clicking on the "Continue" button below.

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* 1. What prompted you to take this survey today?

I saw a link on the website

I saw a link or a reference to the survey on paperwork related to my examination

I had an experience with MCN which I'd like to discuss/provide feedback on, so I searched your site for a place to do so (You may input your feedback in the free text box at the end of the survey. We'd appreciate your completing the rest of the survey as well, as your thoughts and experiences are valuable to us.)

Other (You may input your feedback in the free text box at the end of the survey)

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* 2. Where did the examination occur?

At an MCN office

In the doctor's office

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* 3. For what type of insurance was the examination completed?

Disability or Absence Management

Workers' Compensation

Auto/PIP/Liability/Casualty

I'd rather not say

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* 4. Please read each of the following statements. Using the ratings scale below, please tell us whether the phrase describes your experience with MCN. Please select "Unsure" if you can't remember that particular circumstance. Throughout this survey, we refer to the medical professional(s) who conducted your examination(s) as "providers."

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* 5. The provider was:

On time

15 minutes late

30 minutes late

More than 30 minutes late

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* 6. If the provider was late, did the office staff keep you updated on the schedule while you were waiting?

Yes

Yes, but not frequently enough or their information was incorrect

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* 7. Please rate the following aspects of the your experience:

	Excellent	Good	Fair	Poor	Unacceptable
The overall condition of the office was	The overall condition of the office was Excellent	The overall condition of the office was Good	The overall condition of the office was Fair	The overall condition of the office was Poor	The overall condition of the office was Unacceptable
My overall experience with MCN prior to the examination was	My overall experience with MCN prior to the examination was Excellent	My overall experience with MCN prior to the examination was Good	My overall experience with MCN prior to the examination was Fair	My overall experience with MCN prior to the examination was Poor	My overall experience with MCN prior to the examination was Unacceptable
My overall experience of the examination was	My overall experience of the examination was Excellent	My overall experience of the examination was Good	My overall experience of the examination was Fair	My overall experience of the examination was Poor	My overall experience of the examination was Unacceptable

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* 8. Please rate the quality of the office and the MCN staff based on the following criteria:

	Yes	Generally yes, but there were exceptions	No	Not sure	Not applicable
My appointment was at a convenient time	My appointment was at a convenient time Yes	My appointment was at a convenient time Generally yes, but there were exceptions	My appointment was at a convenient time No	My appointment was at a convenient time Not sure	My appointment was at a convenient time Not applicable
I received a map or directions to the office	I received a map or directions to the office Yes	I received a map or directions to the office Generally yes, but there were exceptions	I received a map or directions to the office No	I received a map or directions to the office Not sure	I received a map or directions to the office Not applicable
I received a reminder call the day before the appointment	I received a reminder call the day before the appointment Yes	I received a reminder call the day before the appointment Generally yes, but there were exceptions	I received a reminder call the day before the appointment No	I received a reminder call the day before the appointment Not sure	I received a reminder call the day before the appointment Not applicable
The written material explaining the purpose of the exam was clear	The written material explaining the purpose of the exam was clear Yes	The written material explaining the purpose of the exam was clear Generally yes, but there were exceptions	The written material explaining the purpose of the exam was clear No	The written material explaining the purpose of the exam was clear Not sure	The written material explaining the purpose of the exam was clear Not applicable
I understand the reason for the examination	I understand the reason for the examination Yes	I understand the reason for the examination Generally yes, but there were exceptions	I understand the reason for the examination No	I understand the reason for the examination Not sure	I understand the reason for the examination Not applicable
The office staff treated me with respect	The office staff treated me with respect Yes	The office staff treated me with respect Generally yes, but there were exceptions	The office staff treated me with respect No	The office staff treated me with respect Not sure	The office staff treated me with respect Not applicable
The office staff was mindful of my right to privacy	The office staff was mindful of my right to privacy Yes	The office staff was mindful of my right to privacy Generally yes, but there were exceptions	The office staff was mindful of my right to privacy No	The office staff was mindful of my right to privacy Not sure	The office staff was mindful of my right to privacy Not applicable
The office staff answered all of my questions	The office staff answered all of my questions Yes	The office staff answered all of my questions Generally yes, but there were exceptions	The office staff answered all of my questions No	The office staff answered all of my questions Not sure	The office staff answered all of my questions Not applicable
The office staff was professional	The office staff was professional Yes	The office staff was professional Generally yes, but there were exceptions	The office staff was professional No	The office staff was professional Not sure	The office staff was professional Not applicable
The waiting area was clean	The waiting area was clean Yes	The waiting area was clean Generally yes, but there were exceptions	The waiting area was clean No	The waiting area was clean Not sure	The waiting area was clean Not applicable
The waiting area was comfortable	The waiting area was comfortable Yes	The waiting area was comfortable Generally yes, but there were exceptions	The waiting area was comfortable No	The waiting area was comfortable Not sure	The waiting area was comfortable Not applicable
The examination room was clean	The examination room was clean Yes	The examination room was clean Generally yes, but there were exceptions	The examination room was clean No	The examination room was clean Not sure	The examination room was clean Not applicable

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* 9. We'd appreciate your comments/suggestions regarding the examination and your overall experience with MCN:

100% of survey complete.

	Yes	No	Unsure	Not Applicable
The Provider introduced her/himself to me	The Provider introduced her/himself to me Yes	The Provider introduced her/himself to me No	The Provider introduced her/himself to me Unsure	The Provider introduced her/himself to me Not Applicable
The Provider told me their specialty	The Provider told me their specialty Yes	The Provider told me their specialty No	The Provider told me their specialty Unsure	The Provider told me their specialty Not Applicable
The Provider explained to me the purpose of the exam	The Provider explained to me the purpose of the exam Yes	The Provider explained to me the purpose of the exam No	The Provider explained to me the purpose of the exam Unsure	The Provider explained to me the purpose of the exam Not Applicable
The Provider asked about my injury/illness	The Provider asked about my injury/illness Yes	The Provider asked about my injury/illness No	The Provider asked about my injury/illness Unsure	The Provider asked about my injury/illness Not Applicable
The Provider asked about how I became injured/about the onset of my condition	The Provider asked about how I became injured/about the onset of my condition Yes	The Provider asked about how I became injured/about the onset of my condition No	The Provider asked about how I became injured/about the onset of my condition Unsure	The Provider asked about how I became injured/about the onset of my condition Not Applicable
The Provider listened to my concerns	The Provider listened to my concerns Yes	The Provider listened to my concerns No	The Provider listened to my concerns Unsure	The Provider listened to my concerns Not Applicable
The Provider asked about my other medical problems	The Provider asked about my other medical problems Yes	The Provider asked about my other medical problems No	The Provider asked about my other medical problems Unsure	The Provider asked about my other medical problems Not Applicable
The Provider treated me with respect	The Provider treated me with respect Yes	The Provider treated me with respect No	The Provider treated me with respect Unsure	The Provider treated me with respect Not Applicable
The Provider conducted him/herself in a professional manner during the examination	The Provider conducted him/herself in a professional manner during the examination Yes	The Provider conducted him/herself in a professional manner during the examination No	The Provider conducted him/herself in a professional manner during the examination Unsure	The Provider conducted him/herself in a professional manner during the examination Not Applicable
The Provider reviewed my records with me	The Provider reviewed my records with me Yes	The Provider reviewed my records with me No	The Provider reviewed my records with me Unsure	The Provider reviewed my records with me Not Applicable
The Provider took my medical history during the examination	The Provider took my medical history during the examination Yes	The Provider took my medical history during the examination No	The Provider took my medical history during the examination Unsure	The Provider took my medical history during the examination Not Applicable
The Provider spent adequate time conducting the examination	The Provider spent adequate time conducting the examination Yes	The Provider spent adequate time conducting the examination No	The Provider spent adequate time conducting the examination Unsure	The Provider spent adequate time conducting the examination Not Applicable
I saw more than one provider - they were all thorough in their approach to the examination	I saw more than one provider - they were all thorough in their approach to the examination Yes	I saw more than one provider - they were all thorough in their approach to the examination No	I saw more than one provider - they were all thorough in their approach to the examination Unsure	I saw more than one provider - they were all thorough in their approach to the examination Not Applicable
I have had an examination like this (an IME or other independent examination not geared towards providing treatment) before	I have had an examination like this (an IME or other independent examination not geared towards providing treatment) before Yes	I have had an examination like this (an IME or other independent examination not geared towards providing treatment) before No	I have had an examination like this (an IME or other independent examination not geared towards providing treatment) before Unsure	I have had an examination like this (an IME or other independent examination not geared towards providing treatment) before Not Applicable