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1
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Which Provider did you see?
| Dr. Aggarwal |
| Dr. Gornet |
| Dr. Halepota |
| Dr. Langford |
| Dr. Mamani |
| Dr. Ondreyco |
| Dr. Rakkar |
| Dr. Volk |
| Dr. Zafar |
| Eileen, PA |
| Linda, PA |
| Molly, PA |
| Shannon, PA |
| Tiffani, PA |
| William, PA |
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2
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Which Location did you visit?
| Thunderbird Location |
| Scottsdale Location |
| Avondale Location |
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3
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Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree | N/A
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| The person who scheduled your appointment was courteous |
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| Your appointment was scheduled within a reasonable amount of time |
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| The office check-in process was efficient |
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| The person who greeted you was friendly and courteous |
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| The wait time in the reception area met your expectation |
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| The wait time in the exam room met your expectation |
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| You were kept informed if your appointment time was delayed |
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4
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1
Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree | N/A
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| You were seen promptly for scheduled visits with the clinical staff |
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| The clinical staff demonstrated knowledge and skill |
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| The clinical staff was courteous |
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| The clinical staff were compassionate |
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| You were seen for Chemotherapy on time |
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5
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The Physician, Physician Assistant or Nurse Practitioner
1
Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree | N/A
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| Your physician/APRN/PA displayed a willingness to listen carefully to your concerns |
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| Your physician/APRN/PA took the time to answer your questions |
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| The amount of time the physician/APRN/PA spent with you met your expectations |
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| Your physician/APRN/PA explained things in a way you could understand |
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| Instructions regarding medication/treatment plan and follow-up care were explained clearly |
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6
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Communications
1
Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree | N/A
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| Your phone calls are answered promptly during business hours |
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| Your calls are returned in a timely manner |
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| Your ability to contact us after hours and receive a timely response meets your expectation |
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| Your test results were reported in a reasonable amount of time |
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| If you needed assistance after office hours, was your call returned satisfactorily? |
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7
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1
Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree |
| The waiting room is comfortable and pleasant |
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| The exam rooms are comfortable and pleasant |
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| The chemotherapy room is comfortable and pleasant |
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| The staff that assisted you with billing or insurance was helpful |
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8
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YOUR OVERALL SATISFACTION WITH
1
Strongly Agree | 2
Agree | 3
Disagree | 4
Strongly Disagree | N/A
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| Your overall experience with Palo Verde met your expectations |
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| You would recommend our practice to others |
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9
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We would appreciate any comments or suggestions regarding your experience with our practice:
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11
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| 18-30 |
| 31-40 |
| 41-50 |
| 51-64 |
| 65-79 |
| 80+ |
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