QUALITY OF ACCESS How did you originally hear about our office? Physician (please name in space below) Friend/Family Member Advertising/Website Lecture Series Other (please describe in space below)
Please name referring physician or other referral source
How long have you been a patient at Southeastern Neurosurgical & Spine Institute (SENSI)? Less than 1 year 1-3 years 3-5 years More than 5 years
Did you know that SENSI is part of Greenville Hospital System? Yes No
In which location were you most recently seen? Patewood Cross Creek
Did you observe your provider wash/sanitize his/her hands? Yes No
In the answers below, please score from 4 (best experience) to 1 (worst experience) How would you rate the ease of making an appointment? 4 3 2 1
In the answers below, please score from 4 (best experience) to 1 (worst experience) How would you rate your appointment CHECK IN experience? 4 3 2 1
In the answers below, please score from 4 (best experience) to 1 (worst experience) How would you rate your appointment CHECK OUT experience? 4 3 2 1 CLINICAL ENVIRONMENT How long did you wait to be seen after your scheduled appointment time? Did not have to wait Less than 15 minutes 15-30 minutes 30-45 minutes over 45 minutes
Do you feel this was an appropriate wait time? Yes No
In the answers below, please score from 4 (best experience) to 1 (worst experience) What was your overall impression of your physician? 4 3 2 1
In the answers below, please score from 4 (best experience) to 1 (worst experience) How would you rate the clinical staff? 4 3 2 1
Was the clinic clean and inviting? Yes No
In the answers below, please score from 4 (best experience) to 1 (worst experience) What was your overall impression of our clinic? 4 3 2 1
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