Dear Patient,

It is our desire at Shreveport Endoscopy Center, A.M.C., to provide you with the finest in modern medical care and to provide this in a courteous, friendly, and efficient atmosphere.  To assist us in achieving this goal, we ask for your evaluation and observations.
 
Please take a few minutes to complete this questionnaire.  Your comments and impressions will remain confidential and will be used to improve the services we provide. Our Sincere thanks for your time and help  
 
Thank You! 

* 1. Please tell us whom your procedure was with.

* 2. What day was your procedure on?

Date / Time
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* 3. When I called for my appointment:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. the phone was answered promptly and courteously
b.  the appointment was made in a professional and efficient manner

* 4. When I arrived for my appointment:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. the receptionist greeted me promptly in a courteous manner and made me feel welcome
b. the reception area was relaxing and had adequate and comfortable seating
c. I was called from the reception area to the procedure area in a reasonable period of time, or was notified of any delays

* 5. The Nursing personnel:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. were pleasant and courteous as well as caring and attentive
b. explained policies and procedures accurately and helpfully, including any instructions to be followed after the procedure
c. were professional and appeared knowledgeable with regard to their duties

* 6. My Doctor:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. appeared genuinely interested in me as a person as well as my problem and also my safety and comfort
b. gave me adequate medication to keep me reasonably comfortable during my procedure
c. fully explained the findings of my examination and any recommendations to me and/or my accompanying family member

* 7. General:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. when I call your office and leave a message, my call is returned in a reasonable amount of time
b. results of my tests were reported promptly
c. billing procedures were explained to me prior to my procedure in a clear, straightforward, and professional manner

* 8. Personal:

  Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Does Not Apply
a. I feel my experience at your center will result in improvement in my helath and/or sense of well being
b. I would recommend your center to my family and friends

* 9. Please list two suggestions that would make your visit to our center more enjoyable.

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