Edina Pain Clinic - Patient Survey Form - Twin Cities Pain Clinic MN

Patient Survey Form
1. Were you able to get this appointment as soon as you wanted? * 2. Please rate your response to the following questions with the choice that best fits your experience: Excellent, Very Good, Good, Fair, Poor. A. How would you rate your overall experience at Twin Cities Pain Clinic? * B. The ease of scheduling at the clinic? * C. The courtesy of the reception area staff? * D. The length of time you spent waiting in the reception area? * E. The length of time you spent waiting in the exam room? * F. The courtesy of the nursing staff? * G. The courtesy of the practitioner you saw at your last visit? * 3. Did you have a full understanding of your plan of care at the end of your appointment? * 4. If you have left a question on our nurse triage line, did you receive a call back within 24 hours? * 5. Would you recommend Twin Cities Pain Clinic to a friend or family member? * 6. How long has it been since your last appointment at Twin Cities Pain Clinic? * 7. How did you hear about Twin Cities Pain Clinic? (Fill in the blank) * 8. Would you be willing to share your opinions from this survey on our website? If so please provide us with our first name and last initial. * 9. Would you like to provide us with your name and contact information: *