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Initial Visit Evaluation

HemOnCare - providing the finest Hematology/Oncology care in Brooklyn

 

Home Staff Facilities Directions Preparing for a Visit Feedback HIPAA

 

We are constantly looking for ways to provide you with the best possible medical care.  Your impressions and comments are an important part of this process.  Your comments will be kept strictly confidential.  Thank you for your help.

  1. Did you first come to HemOnCare because of:

    Location
    Doctor referral
    Patient referral
    Insurance Coverage

  2. How long did you wait for your first appointment:

    days    

  3. The person who answered your phone calls was:

    Friendly and helpful
    Neutral
    Impersonal

  4. When you arrived, the welcome you received was:

    Friendly and interested
    Neutral
    Impersonal

  5. Which doctor did you see?

  6. How long did you wait to be seen by the doctor?

    minutes

  7. Were you satisfied with the staff?

    Yes No

  8. If no, why?


  9. Was teaching adequate?


  10. How long did you wait for treatment?

    minutes

  11. If you had blood drawn, were you satisfied with the staff?


  12. If no, why not?


  13. If you needed to speak to the billing office, were you satisfied with the staff and the way in which your concerns were addressed?

    Yes No

  14. If no, why not?


  15. Were you satisfied with the amount of time the doctor spent with you?

    Yes No

  16. Was your doctor:

    Friendly and personal
    Neutral
    Impersonal

  17. Your doctor's explanation of your condition and treatment was:

    Excellent
    Adequate
    Poor

  18. Were you satisfied with the medical treatment that you received?

    Yes No

  19. Would you refer your family and friends to this medical office?

    Yes
    No
    Maybe

  20. Today's Date:


  21. Please add any additional comments in the box below.


  22. Optional: Please fill out your name and telephone number if you wish to be contacted personally about your concerns and questions

    Name
    Home Phone
    E-mail
 

DISCLAIMER: The HemOnCare Online website is designed for educational purposes only and is not for the purpose of rendering medical advice or professional services.  The information provided at the website should not be used for diagnosing or treating a health problem or disease.  It is not a substitute for professional care.  Any specific questions you may have regarding an individual's medical condition, including concerns you may have related to chemotherapy, radiation therapy, or other cancer therapies should be directed to the individual's primary care physician or other attending physician.  In addition, if you have or suspect you may have a health problem, you should consult your health care provider.

Send mail to akiva@hemoncare.com with questions or comments about this web site.
Last modified: February 21, 2003

© Akiva Novetsky