Location:
--- Select VPI Location ---
Ashland Medical Center
Cold Harbor Family Medicine
Hematology and Oncology
Internal Medicine Division: Parham Primary Care
VPI Laboratory Service
Medical Specialists Division: Gastroenterology/Rheumatology
Midlothian Family Practice: Village Office
Midlothian Family Practice: Waterford Office
Midlothian Family Practice: Powhatan Office
Midlothian Medical Care
Radiology Imaging Center
You are a:
New Patient
Existing Patient
The date of your appointment was:
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Day:
01
02
03
04
05
06
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09
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25
26
27
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31
Year:
2005
2006
2007
2008
2009
Your appointment was with Dr.
Please rate the statements below using the following scale:
1 = Very Dissatisfied
2 = Somewhat Dissatisfied
3 = Somewhat Satisfied
4 = Very Satisfied
NA = Not Applicable
WHEN SCHEDULING YOUR APPOINTMENT...
1
2
3
4
NA
1.
Telephone answered promptly
2.
Courteous and caring attitude of staff scheduling appointment
3.
Convenience of appointment time
4.
Convenience of the location
5.
Directions to office offered
6.
You Received a call from the office reminding you of this appointment
7.
Comments:
REGISTRATION AND CHECK OUT PROCESS…
1
2
3
4
NA
1.
Ease of parking and access to the building
2.
Prompt check-in process
3.
Courteous and caring check-in staff
4.
Effectiveness of check-in staff in handling registration
5.
Follow-up appointment handled efficiently
6.
Co-pay and insurance issues handled efficiently
7.
Effectiveness of handling referral request
8.
Courteous and caring attitude of referral coordinator
9.
Comments:
YOUR EXAM AND CARE...
1
2
3
4
NA
1.
Wait time before being seen by clinician/physician
2.
Courteous and caring attitude of clinical staff (nurses, lab techs, x-ray techs)
3.
Courteous and caring attitude of physician
4.
Physician explained medical issues thoroughly
5.
Understanding of your condition after your visit
6.
Environment pleasant and clean
7.
Educational materials presented to you regarding your condition
8.
Comments:
ACCOUNTING/BILLING...
1
2
3
4
NA
1.
Courteous and caring attitude of billing staff
2.
Billing questions were explained thoroughly
3.
Billing inquires left on voice mail were returned with in 24 - 48 hours or 1 - 2 business days
4.
Comments:
YOUR OVERALL EXPERIENCE...
1.
Would you return to Virginia Physicians, Inc.?
Yes
No
2.
Would you recommend Virginia Physicians, Inc. to your family and friends?
Yes
No
OPTIONAL...
1.
Name:
2.
Contact number:
3.
Best time of the day to reach you:
