Patient Satisfaction Survey
Your feedback matters! Please take a moment to fill out our patient satisfaction survey. Your opinions are vital to us, as our patients are our top priority.
Please select the clinic location where you are/were receiving treatment:
Please Select
Tuscaloosa
Winfield
Demopolis
Jasper
Selma
Montgomery
Gadsden
Anniston
Fort Payne
Sylacauga
Who is your provider?
Is this your first time in our facility?
Yes
No
What type of medical treatment are/were you receiving?
Radiation Oncology
Medical Oncology
Hematology
How frequently do you visit our facility?
Weekly or more
Monthly
Quarterly
Less than quarterly
How satisfied are you with the scheduling process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How satisfied are you with check in and welcoming process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How long did you need to wait for the appointment? (past the appointment time)
Less than 30 min.
30 min. - 45 min.
45 min. - 60 min.
More than 60 min.
Please rate the followings:
Professionalism of staff
1
2
3
4
5
Hygiene in the facility
1
2
3
4
5
Kindness of medical personnel
1
2
3
4
5
Care provided by the doctor
1
2
3
4
5
Co-ordination between departments
1
2
3
4
5
By considering overall experience with our facility, how likely would you recommend to your friends/family?
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
Please share any comments/suggestions
Would you like your submission to remain anonymous? If so, please select "Yes" below:
Yes
No
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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