Southern Eye Specialists - Referrer Survey

Thank you for taking the time to engage with us. This is a long overdue opportunity to seek insight from our Referrers and our commitment to you, is to take direct positive action from your feedback toward improving our working relationship with you.

Question Title

* 1. Do you refer patients to Southern Eye Specialists?

No not at all

I have previously referred patients but no longer do so

I occasionally refer patients but now prefer other Ophthalmic avenues

I regularly refer patients

I will always refer patients to you as a priority

Question Title

* 2. Do you know enough about Southern Eye Specialists services to be confident in referring your patients to us?

I have no interest in improving my knowledge of Southern Eye Specialists services

I have limited knowledge of Southern Eye Specialists services and would like to know more

I am fairly knowledgeable of Southern Eye Specialists services but could do with more regular information flow

I am confident in knowledge of Southern Eye Specialists services

Question Title

* 3. What further information from us would improve your confidence in referring patients to Southern Eye Specialists?

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* 4. How responsive are we to your queries or concerns prior to, during, and post patient referrals?

I do not know/I do not refer to Southern Eye Specialists

Non responsive or very slow to respond/follow up

Generally acceptable timeframes in responding

Very responsive

I do not know/I do not refer to Southern Eye Specialists

Non responsive or very slow to respond/follow up

Generally acceptable timeframes in responding

Very responsive

Question Title

* 5. What feedback do you receive from your patients regarding their contact with us?

Question Title

* 6. Are we an ophthalmology services 'provider of choice'?

Yes

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* 7. How satisfied are you with Southern Eye Specialists interaction with your business and/or your referred patients?

Dissatisfied - would refer patients elsewhere

Satisfied - refer patients to Southern Eye Specialists on a regular basis

Very satisfied - refer patients to Southern Eye Specialists without hesitation

Dissatisfied - would refer patients elsewhere

Satisfied - refer patients to Southern Eye Specialists on a regular basis

Very satisfied - refer patients to Southern Eye Specialists without hesitation

Question Title

* 8. If you are dissatisfied (2 stars or less) and do not refer patients to us, what can we do to improve our relationship with you and/or your patients?

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* 9. Are there any other comments you would like to add?

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* 10. Would you like our GM or a Director to contact you directly to discuss ways we can actively improve our relationship with you?

Name

Email Address

Phone Number

Thank you for taking the time to engage with us. This is a long overdue opportunity to seek insight from our Referrers and our commitment to you, is to take direct positive action from your feedback toward improving our working relationship with you. OK

Question Title

* 1. Do you refer patients to Southern Eye Specialists?

Question Title

* 2. Do you know enough about Southern Eye Specialists services to be confident in referring your patients to us?

Question Title

* 3. What further information from us would improve your confidence in referring patients to Southern Eye Specialists?

Question Title

* 4. How responsive are we to your queries or concerns prior to, during, and post patient referrals?

Question Title

* 5. What feedback do you receive from your patients regarding their contact with us?

Question Title

* 6. Are we an ophthalmology services 'provider of choice'?

Question Title

* 7. How satisfied are you with Southern Eye Specialists interaction with your business and/or your referred patients?

Question Title

* 8. If you are dissatisfied (2 stars or less) and do not refer patients to us, what can we do to improve our relationship with you and/or your patients?

Question Title

* 9. Are there any other comments you would like to add?

Question Title

* 10. Would you like our GM or a Director to contact you directly to discuss ways we can actively improve our relationship with you?

Thank you for taking the time to engage with us. This is a long overdue opportunity to seek insight from our Referrers and our commitment to you, is to take direct positive action from your feedback toward improving our working relationship with you.