Patient Survey
We at the Virginia Spine Institute are concerned about the quality of experience that is provided to all our patients. This questionaire lets us know how you, our most valued asset, feel about your overall spinal care experience. Our goal is to continually assist you with the best spinal care available today.
1. About You (All information is optional)
Name:
Age:
Sex: Male Female
Street:
City:
State:
Zip:
Email:
2. General Info
a. Who is your regular doctor:
Dr. Schuler
Dr. Hasz
Dr. Subach
Dr. Nguyen
Dr. Kancherla
b. How long have you been a patient at VSI?
c. How were you referred to VSI?
3. Office
a. The convenience of of our office location is:
Poor Fair Good Very Good Excellent
b. The length of time you waited to get an appointment was:
Poor Fair Good Very Good Excellent
c. The comfort of the waiting room is:
Poor Fair Good Very Good Excellent
d. The length of time in the waiting room was:
Poor Fair Good Very Good Excellent
e. The length of time waiting in the examining room was:
Poor Fair Good Very Good Excellent
4. Physician Care
a. The doctor's interest in your health is:
Poor Fair Good Very Good Excellent
b. The doctor's advice about your specific spinal condition is:
Poor Fair Good Very Good Excellent
c. Amount of time the doctor spends with you is:
Poor Fair Good Very Good Excellent
d. The treatment and progress of your condition is:
Poor Fair Good Very Good Excellent
5. Physician Assistant Care
a. The PA's interest in your health is:
Poor Fair Good Very Good Excellent
b. The PA's advice about your specific spinal problem is:
Poor Fair Good Very Good Excellent
c. The amount of time the PA spends with you is:
Poor Fair Good Very Good Excellent
6. Office Personnel
a. The customer service skills of our front office personnel are:
Poor Fair Good Very Good Excellent
b. The courteous manner in which your phone calls are handled is:
Poor Fair Good Very Good Excellent
c.The overall service provided by the front office personnel is:
Poor Fair Good Very Good Excellent
7. General Satisfaction
a.The visit overall was:
Poor Fair Good Very Good Excellent
b. The chance of recommending your family and friends to us:
Poor Fair Good Very Good Excellent
8. Comments:
    
 
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