SATISFACTION SURVEY Appointment Information 1. Which office location did you visit? —Please choose an option—JesupWaycrossHinesvilleBaxley 2. Which Provider did you see? —Please choose an option—J. Lex Kenerly, III, MDJ. Matthew Valosen, MDThomas P. Loumeau, MDT. Jordan Polander, MDBrian T. Grisez, MDW. Scott Rowell, P.A.Kyle Deuter, P.A.-CG. Heath Denmark, P.A.-C 3. Are you a new or returning patient? —Please choose an option—New PatientReturning Patient 4. How did you first learn of our practice? —Please choose an option—Friend / RelativeMy PhysicianBillboardGoogle SearchFacebookNewspaperInsuranceOther Please provide a name so we can say thanks: Please explain: Please rate your level of satisfaction for the following: N/A - Not Applicable | 1 - Strongly Disagree | 2 - Disagree | 3 - Neutral | 4 - Agree | 5 - Strongly Agree Before Your Appointment 5. When scheduling an appointment, the staff was courteous and helpful. N/A12345 Best 6. I was able to make an appointment for a date and time that was reasonable and convenient to me. N/A12345 Best Check In 7. I was greeted and checked in promptly. N/A12345 Best 8. The registration staff was courteous and helpful. N/A12345 Best 9. The ability to access forms on the website made the registration process more convenient and efficient. N/A12345 Best 10. My wait time was reasonable. N/A12345 Best Your Appointment 11. My healthcare provider was compassionate. N/A12345 Best 12. My healthcare provider gave me enough time to ask questions. N/A12345 Best 13. My healthcare provider sufficiently answered my questions. N/A12345 Best 14. My diagnosis and treatment was adequately explained. N/A12345 Best 15. The medical staff was professional and helpful. N/A12345 Best 16. I know to ask follow-up questions after my appointment. N/A12345 Best 17. I was able to easily schedule my next appointment. N/A12345 Best General 18. Did we explain all of your charges clearly? YesNoN/A 19. Were your phone calls returned within 24 hours? YesNoN/A 20. Did you visit our website before or after your appointment to learn more? YesNo MRI 21. I was contacted in a timely manner to schedule my MRI appointment? N/A12345 Best 22. I was made to feel comfortable during my MRI? N/A12345 Best 23. All of my questions about my MRI was answered? N/A12345 Best Overall Satisfaction 24. What is your overall level of satisfaction with our practice? N/A12345 Best 25. Would you recommend BJISG to a friend or family member? YesNo 26. We welcome additional comments or recommendations on ways to improve our service:
