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Patient Survey

Carolina Urology Partners Patient Survey
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Carolina Urology Partners would like to thank you in advance for taking a moment to complete this survey. We value your input as we consistently strive to provide high quality patient care!

This survey will provide us with valuable information on how we can enhance our services. All submissions are anonymous therefore if you wish to be contacted about your response, please leave your name and phone number in the additional comments section of the last question.

Medical information, test results and prescription requests must be handled with your doctor's nurse and can not be handled through this survey.
 
 
 
1. Which physician did you see today?
   
 
 
 
2. Which Carolina Urology location did you visit today?
 
Gaston
 
Lake Norman Mooresville
 
Lake Norman Huntersville
 
Northeast Concord
 
Northeast Harrisburg
 
Piedmont Gastonia
 
Piedmont Charlotte
 
Providence Monroe
 
Providence Matthews
 
Rockhill
 
Fort Mill
 
Lancaster
 
Shelby
 
West Columbia
 
Irmo
 
Lexington
 
West Columbia Main
 
 
 
3. Is this your?
 
First Visit
 
Return Visit
 
 
 
4. Why did you decide to seek medical treatment at this office?
 
Near home or office
 
Physician referral
 
Family member referral
 
Refered by patient
 
Telephone list
 
Referred by hospital
 
Other
 
 
 
5. If you called our office to schedule an appointment, was the call answered promptly and in a professional manner? If not please explain in the other box.
 
Yes
 
No
 
If no please explain
 
 
 
6. When you arrived at our office, were you greeted and treated courteously by the check-in receptionist?
 
Yes
 
No
 
If no please explain
 
 
 
7. Did we complete your registration quickly and in a professional manner?
 
Yes
 
No
 
If no please explain
 
 
 
8. If applicable, did the Check-in receptionist take your co-pay?
 
Yes
 
No
 
Not Applicable
 
 
 
9. How long did you wait in the reception area before going to the exam room?
 
Less than 15 minutes
 
15 to 30 minutes
 
31-45 minutes
 
Over 45 minutes
 
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