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PATIENT SATISFACTION SURVEY

PRIVACY STATEMENT: All information submitted is considered strictly confidential and will never be sold, traded or given to any third party for any reason whatsoever. *Information collected will be used to contact you exclusively by Beverly Hills Physicians.com.

General Information
*1. E-mail Address: *2. Phone Number: (10 digit)
*3. First Name: *4. Last Name:
5. May we use your comments as testimonials for future BHP Advertising? Yes    No
6. Gender: Male   Female Transgender
7. Age Group: 18-25 26-35 36-45 46-55 over 55
8. Date of Procedure: (mm/dd/yyyy)
*9. Which facility did you visit?
10. Which procedure(s) did you have?
*11. Who was your Surgeon?
*12. Who was your Surgery Consultant?

Call Center Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. The Call Center Operator was courteous and professional.
2. A convenient and timely appointment was easily scheduled.
3. The Call Center Operator was knowledgeable and informative.
4. I received a call to confirm my appointment. Yes    No
5. Overall, how would you rate your experience with our Call Center.
6. Please provide any additional comments or concerns you may have:

Front Office Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. The Receptionist was courteous and professional.
2. My Appointment began at its scheduled time. Yes    No
3. The receptionist informed me of any appointment delays. Yes    No  Not Applicable
4. Please provide any additional comments or concerns you may have:

Consultant Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. My Consultant was courteous and professional.
2. My Consultant was knowledgeable and informative.
3. My Consultant was easy to reach and available when needed.
4. My Consultant called to introduce herself prior to my appointment. Yes    No
5. My Consultant followed up with me until I reached a decision about my procedure(s).
Yes    No  Not Applicable
6. My Consultant informed me of other services offered at this facility. Yes    No
7. Did you receive a BHP Thank You card from you consultant?Yes    No
8. Overall, describe your Consultant's performance.
9. Please provide any additional comments or concerns you may have:

Surgeon Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. My Surgeon educated me about the entire process prior to surgery.
2. My Surgeon spent the necessary amount of time with me to address all of my concerns.
3. My Surgeon listened to me and helped me set realistic expectations.
4. My Surgeon was courteous and professional.
5. My Surgeon was on time for office visits.
6. I was satisfied with my Surgeon's availability after surgery.
7. Did you receive a telephone call from your Surgeon the night of your surgery? Yes    No
8. Overall, how would you rate your experience with your Surgeon.
9. Overall, how would you describe the results of your procedure(s).
10. Please provide any additional comments or concerns you may have:

Operating Room Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. The Operating Staff made me comfortable.
2. The Operating Staff was courteous and professional.
3. Overall, how would you rate your experience with our Operating Staff?
4. Overall, how would you rate your experience with our anesthesia provider?
5. Please provide any additional comments or concerns you may have:

Facility Experience
 
Poor
Below Average
Average
Above Average
Excellent
1. The atmosphere at the Facility was calm and serene.
2. How would you rate the appearance and decor of the facility?
3. How would you rate the cleanliness of the facilty?
4. Please provide any additional comments or concerns you may have:
5. If you could change one thing about your experience with BHP, what would it be?
6. What was the primary reason you have chosen BHP? (Reputation, Surgeon, Referral, Price, Location etc.)
7. Would you refer a friend to BHP? Yes    No
8. If you were to consider another procedure in the future, would you return to BHP? Yes    No


Required fields have an asterisk (*) in front of them. Please complete the above form and click "Submit Survey" at the bottom. As always your contact information will be kept strictly confidential.


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Beverly Hills Physicians Institute, A Medical Group provides cosmetic and plastic surgery services throughout Southern California including Los Angeles, Beverly Hills, Encino, San Gabriel, Huntington Park, Oxnard, Thousand Oaks, Torrance, Valencia, and in Los Angeles County, Ventura County. Copyright © 2005 - 2007 Beverly Hills Physicians Institute, A Medical Group - All rights reserved. Privacy Policy.