Physician Survey

Physician Survey

Dear Provider,

Thank you for collaborating with us in providing Hospice care to your patient. To help us evaluate our care and obtain your thoughts about our program, would you please take the time to complete the enclosed questionnaire. Please feel free to add any additional comments you may have for our Agency.

Thank you in advance for your cooperation.

Tracey Tavano, MSN, RN, CHPN
Director of Patient Services

The process of admitting your patient to Hospice of the North Country worked well?




Please make a selection.

Hospice of the North Country staff provided notification of patient's condition change(s) in a timely manner?




Please make a selection.

Hospice provided an appropriate amount of information to me about my patients?




Please make a selection.

Medication recommendations and doses requested by Hospice staff were appropriate?




Please make a selection.

Hospice of the North Country provided a variety of skills, services and programs necessary to meet the needs of patient and family?




Please make a selection.

Your patient's physical symptoms were managed effectively by our clinical staff while under Hospice care?




Please make a selection.

Overall communication between Hospice and your office was always professional and courteous?




Please make a selection.

Hospice of the North Country positively influenced the quality of life for your patient and family during end-of-life care?




Please make a selection.

Your overall satisfaction with the services provided by Hospice of the North Country?




Please make a selection.

The likelihood that you would refer future patients to Hospice of the North Country?




Please make a selection.

Additional comments or ways we can improve our services to either you or your patients and families?
Optional Information:
Name (Title) of Responder:
Date:
Phone:
(xxx) xxx-xxxx
Email:
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