Referral Practice Survey Step 1 of 7 14% Thank you for trusting us. To continue to provide quality GI care to your patients, we would like to get your feedback on a few aspects of our practice. Practice(s) Name* How have you contacted our office to schedule an appointment?*Select ANY that apply. EPIC Calling Fax Appointment Coordinators N/A Which is your preferred method of contacting our office?* EPIC Calling Appointment Coordinators Fax Why? Did you know that Digestive Health Specialists has appointment coordinators in place to assist you?* Yes No We have two coordinators available to assist with urgent appointment scheduling/specific scheduling requests. You may reach out to them Monday-Friday 8-5pm: Stacy: (336) 397-5255 & Marsha: (336) 397-5232 or through email at ApptCoordinator@digestivehealthspecialists.flywheelsites.com Have you contacted our appointment coordinators?* Yes No Was this helpful?* Yes No Appointment Coordinator Performance*Please rate the performance of our appointment coordinators based on the characteristics below. ExcellentVery GoodGoodFairPoorAccessibility of coordinatorsKnowledge of coordinatorsAppointment availabilityAdditional Comments:* Of the patients referred to Digestive Health Specialists, how many are for screening purposes?*(i.e. colonoscopy, endoscopy, etc) * Please indicate the most accurate percentage. 0% - 25% 26% - 50% 51% - 75% 76% - 100% Of the patients referred to Digestive Health Specialists, how many were for a diagnostic visit?** Please indicate the most accurate percentage. 0% - 25% 26% - 50% 51% - 75% 76% - 100% What are the top 3 reasons for choosing Digestive Health Specialists, for your patients?*Reason 1Reason 2Reason 3 If you could receive gastroenterology information, what topics would be of most interest?*#1#2#3 In terms of our referral experience, how would you rate Digestive Health Specialists? Appointment Availability* Excellent Very Good Good Fair Poor Ease of scheduling* Excellent Very Good Good Fair Poor Friendliness of phone scheduling staff* Excellent Very Good Good Fair Poor Quality of treatment options* Excellent Very Good Good Fair Poor Turnaround time of follow-up reports* Excellent Very Good Good Fair Poor Overall experience* Excellent Very Good Good Fair Poor Additional Comments:* TestimonialBy checking the box below, you authorize us to use the comments provided throughout this survey as part of our testimonials. I agree This survey is anonymous, but if you would like to provide your information for us to follow-up on your comments, please fill our the information below. NamePlease indicate name of person filling out this form. First Last Position PhoneEmail Additional Comments:PhoneThis field is for validation purposes and should be left unchanged.
Digestive Health Specialists
