Evaluation Form

In an effort to continually improve the quality of care and services we provide to our patients, we would appreciate you taking a few minutes to tell us about your experience here at Pediatric Cardiology Center of Oregon.

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Patient Info:

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Cardiologist Seen:

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Prior to your Appointment

Ease of scheduling an appointment?

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Ability to get in to be seen by your child's cardiologist?

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Assistants were prompt in returning calls:

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Front Desk/Scheduling were prompt in returning calls:

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Waiting

Time to be taken back?

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Time to see physician?

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Staff

Were Medical Assistants friendly and helpful?

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Were Front Desk/Scheduling friendly and helpful?

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Did the Medical Assistants answer your questions?

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Did the Front Desk/Scheduling answer your questions?

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Physician

Friendly and courteous to you?

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Clearly explained your child's condition?

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Felt your worries and concerns were heard?

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Do you feel you had enough time with the physician?

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Instructions given to you regarding follow-up care?

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General

Would you recommend us to a friend or family member?

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How did you hear about us?

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Any other comments or concerns?

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Did anyone stand out positively or negatively?

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Are you a new patient?

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