Procedure Survey

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Home
About Dr. Beer
- Location
Office Policies
References

Procedure Survey

Please take a few moments to fill out the following survey regarding your recent procedure. Providing you with THE BEST healthcare is Dr. Beer's goal. Making sure we are referring to THE BEST facilities is very important. This information will help to make sure Dr. Beer is referring to THE BEST facilities. Thank you for your time!

Procedure Survey

Name of Procedure: *

Where was your procedure performed? *

Mercy Medical Center Mercy Imaging Center - Council Street St. Lukes - Unity Point Hospital PCI Medical Pavillon Surgery Center of Cedar Rapids RCI Imaging Center Weland Labs Other

* Indicates required field

Name of Provider who performed / ordered the procedure: *

Would you return to this facility for future procedures? *

Yes No Not Sure

Would you be willing to see this consultant again in the future for either the same or a different medical condition?

Would you recommend this facility to friends and family? *

Yes No Not Sure

Would you refer this consultant to a friend, family member, co-worker, etc?

How would you rate the cleanliness of this facility? *

Very Clean Clean Not Clean Dirty / Unacceptable

How would you related the support staff at this facility? *

Excellent Good Ok / Average Below Average Bad Horrible

How would you rate the parking at this facility? *

Excellent - Very Close Good Average Below Average Not Acceptable - too far to walk

Was this facility your first choice? *

Yes No Not Sure

Was the decision as to where it was performed: (Select all that apply) *

Your decision (Your Preference) Consultants decision (Also Your Preference) Consultants decision (Not Your Preference) Consultant only gave you one option.

Comment *

Your Name: *

Please provide us with your name so that we can track our evaluations of consultants. Please note, this evaluation is confidential.

Your Email (optional): *

Your Phone Number (Optional): *

Submit

Home
About Dr. Beer
- Location
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