MPC SURVEY: Please answer all questions as best as you can. Thank you for participating!
1. What are your expectations when sending patients to MPC ?
  

2. Do you receive patient documentation/notes in a timely manner?
   Yes
   No
   NA…no patients referred at this time
  

3. If you don't schedule your patient's directly, do you want to be notified of your patient’s appointment date with MPC after it     has been set up?
   Yes
   No
   NA…no patients referred at this time
4. How do you feel MPC is meeting the needs of your patients?
   a. Exceeds expectations
   b. Meets Expectations
   c. Does not meet expectations
   d. NA not currently referring
   Comments:
  

5. Are you satisfied with the level of customer service related to the followings:
Yes No NA not currently referring
a. Ease of Scheduling



b. Cooperation/ of MPC office staff


c. Prompt response to requests for information



   Comments:
  

6. Are your patients satisfied with their care/customer service related to followings:
Yes No NA not currently referring
a. Ease of scheduling



b. Wait times


c. Office environment


d. Expectation/explanation of appointment



e. Attentiveness of physician


f. Care provided by nursing staff



   Comments:
  

7. Do you utilize physical and behavioral therapy services provided by MPC?
Yes No  
Physical Therapy



Behavioral Health



   Comments:
  

8. Would you like more information on MPC: Check all that apply
   MPC appointment pads
   MPC online/fax referral forms
   MPC Diagnosis and Treatment Sheet
   Office visit from Physician/CC/PA
   Information on how to obtain pain CEU credits for your staff
   None

   Your office contact name, e-mail or phone# if you would like additional information
  
9. Final comments on how we can improve our service:
  

10. Your office specialty (ex: family, etc...)