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MD MEDICAL CLINICS

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MD Medical Clinics
Client Quality-Care & Service Survey
 Please mail or email survey to mdmed@pacbell.net
To help improve our quality-of-care and service to you, we would value your important input so we can improve in all areas of our service and care to you and your employees. Your participation would be an invaluable tool in serving you.
 
Rating Scale: 1. □ Poor    2. □ Fair    3. □ Average    4. □Good    5. □ Excellent  6. □N/A
 
Front Office:
Please rate MD Medical Clinics overall customer service
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Please rate your wait time
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate the courtesy and politeness you were shown
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate the thoroughness
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate the accuracy
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate the ease in which the problem was solved
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
 
Patient Care:
Please rate if the nurse or doctor introduced themselves?
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate if you felt the overall staff was sympathetic to your condition?
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate ease in which the problem was solved
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate if the doctor answered your questions to satisfaction
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Please rate if the doctor called you (employer) after the patients initial visit
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Page 2
Physical Therapy
Please rate if the physical therapist was courteous and professional
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate if the PT treatment was explained to you in detail
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Please rate if the physical therapist was attentive to you in the treatment area
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
 
Billing / Insurance
Please rate overall customer service with our billing dept.
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate the accuracy and thoroughness your questions were answered
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate courtesy and politeness you were shown
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate timeliness when receiving reports, bills, and feedback
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
 
Marketing
Please rate overall customer service
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate accuracy and troubleshooting by marketing person
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate courteous and politeness shown
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
Please rate timeliness in receiving marketing material & correspondence
1 □ 2 □ 3 □ 4 □ 5 □ N/A □
 
Client Comments
We would appreciate your comments or suggestions for improving our practice, we value your feedback and honor your anonymity – MD Medical Management Team
 
 
 
 
  
 
 
Company___________________________________________________________________
Signed by (optional)_________________________Date__________________________________
 
MD Medical Clinics
1300 N Kraemer Blvd
Anaheim, CA 92806
714-630-6363