Referral Source Satisfaction Survey Please rate how satisfied you are with the following: Question Title * 1. Practice Name and City Practice Name City Question Title * 2. Timeliness of starting your patient on therapy Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 3. Friendliness and helpfulness of staff Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 4. Assistance with insurance related issues Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 5. Communication about the status of your referral Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 6. How likely are you to refer patients to Palmetto Infusion in the future Very Likely Somewhat Likely Neither Likely or Unlikely Somewhat Unlikely Very Unlikely Question Title * 7. Overall Satisfaction with Palmetto Infusion Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 8. Overall ease of utilizing Palmetto Infusion Very Satisfied Somewhat Satisfied Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied Question Title * 9. What can we do to improve our services? Done
