Thank you for participating in this survey. Your experience and perspective are invaluable to the Roselle Center for Healing. Please complete so we may continue to make improvements. Your Name* Your Email* 1.)Did your doctor or therapist provide and thoroughly explain your diagnosis and a treatment plan for your health condition? YesNo 2.) Did you understand the explanation of your condition and treatment plan recommended? YesNo 3.) How would you rate the following to describe your experience with your doctor/provider? Patience/Listened Carefully/Responsive: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ Approachable/Knowledgeable/Confident: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ Provided Supporting Reasons for X-rays/Lab Work: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ Next Steps Outlined/Expectations Explained: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ Financial Options Provided: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ 4.) Overall, please rate the quality of the service that you received during this entire visit: Very Good ★★★★★Good ★★★★Neutral ★★★Poor ★★Very Poor ★ 12.) Would you recommend this office to a colleague, friend, or family member? YesNo If no, please let us know why in the comments box below. Would you like to be contacted by our Patient Advocate regarding any issues that may help us improve? If yes, please provide your phone number: Δ
