Dear Referring Doctors:

We know your time is valuable and in short supply, but we will be very grateful if you will complete this survey. Based on what you tell us here, we pledge to respond with positive changes in serving you and your patients.

Thank you in advance!

The Providers and Administrator of the Urology Center.
Your Name:
Name of Practice:
   
Please provide a response for each item and , if you will, please write any particular comments in the spaces provided.
   
1. Does the Urology Center's staff respond well to your concerns and requests?
  Yes No
  Comments:
   
2. Does the Urology Center make timely appointments for your patients?
  Yes No
  Comments:
   
3. Are you satisfied with the information you receive from us about your patients following their treatment?
  Yes No
  Comments:
   
4. Are you advised when your patients need surgery?
  Yes No
  Comments:
   
5. When a referral is required, does our staff work effectively with your office to get this accomplished?
  Yes No
  Comments:
   
6. Would you like to continue receiving our Uro-flow newsletter?
  Yes No
  Comments:
   
7. Please list topics you would like addressed in future issues of Uro-flow:
 
   
8. Would you prefer our newsletter to appear as:
  A quarterly, 4-page newsletter (current format)
  A monthly, 2-page newsletter
  A bi-monthly, 2-page newsletter
   
9. Please list suggestions for improving our service to you and your patients:
 
   
 
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