Referral Satisfaction Survey
How was your experience referring to Better Health?
Your Name
*
Your Email Address
*
example@example.com
How easy is it to refer patients to our organization?
*
Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
How satisfied are you with the communication you receive regarding referred patients?
*
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
In your view, how well are patients’ needs addressed after referral?
*
Very poor
1
2
3
4
Excellent
5
1 is Very poor, 5 is Excellent
Please share any comments or suggestions about your experience with our referral process.
Submit
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