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onPARC Survey/Assessments


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THE MASTERY COMPANY  
(541) 488-7479  

metrix@emisar.com  






REFERRAL SATISFACTION ASSESSMENT:

onPARC has been contracted by Dr. Randy Nolf to assess periodontal specialty service to Lehigh Valley and Pocono referring doctors. All responses will be held in confidence and your name (optional) will not be revealed at any point in this process.

A final report will be generated from the 'aggregate scores' of all referring doctors who complete this survey. The aggregate report will be sent to the Dr. Nolf and reviewed with an onPARC facilitator.

Dr. Nolf will be happy to review the results of the final report. Experience has shown that this can be a valuable exchange for the referring dentist as well as the specialist.

Thank you in advance for you time and consideration. Please complete the entire survey and then select Submit.

Name (Optional):
Number of years in practice:
Zip Code:
Are you a GP or a specialist?
Referral Duration:
How long have you been referring to a periodontist?
Monthly Referrals:
Approximate number of patients referred to a periodontist per month.
Relationship:
Do you refer primarily to one periodontist?

Please consider the following statements and rate this specialist on a scale of 1 to 10. In this case, 1 represents "Poor" and 10 represents "Excellent."

COMMUNICATION
Please rate each of the statements on a scale of 1 - 10.
[1 = Poor and 10 = Excellent]
1) The feedback I receive from the periodontist occurs in a timely manner.
10    9    8    7    6    5    4    3    2    1   
2) I clearly understand the feedback I receive from the periodontist.
10    9    8    7    6    5    4    3    2    1   
3) I can reach the specialist easily.
10    9    8    7    6    5    4    3    2    1   
4) After being seen by a periodontist, my patients are motivated to accept my treatment recommendations.
10    9    8    7    6    5    4    3    2    1   
COMMENTS: Describe good or bad experiences.
CARE
Please rate each of the statements on a scale of 1 - 10.
[1 = Poor and 10 = Excellent]
5) The specialist’s office meets my patient's emotional needs.
10    9    8    7    6    5    4    3    2    1   
6) The specialist’s office manages my patient’s financial issues well.
10    9    8    7    6    5    4    3    2    1   
7) The specialist meets my quality demands for clinical outcomes.
10    9    8    7    6    5    4    3    2    1   
8) Final treatment results meet my expectations.
10    9    8    7    6    5    4    3    2    1   
COMMENT: Describe good or bad experiences.
ACCESS
Please rate each of the statements on a scale of 1 - 10.
[1 = Poor and 10 = Excellent]
9) My patients can easily schedule appointments at the perio office.
10    9    8    7    6    5    4    3    2    1   
10) The specialist's staff is helpful on the phone.
10    9    8    7    6    5    4    3    2    1   
11) My patients understand what’s going on with their treatment during their time with the specialist.
10    9    8    7    6    5    4    3    2    1   
12) My staff communicates effectively with the specialist's office.
10    9    8    7    6    5    4    3    2    1   
COMMENT: Describe good or bad experiences.
PATIENT MANAGEMENT
Please rate each of the statements on a scale of 1 - 10.
[1 = Poor and 10 = Excellent]
13) I am kept current on my patient's progress in their perio treatment.
10    9    8    7    6    5    4    3    2    1   
14) My patients return to my office satisfied with their specialty care.
10    9    8    7    6    5    4    3    2    1   
15) My patients return to my office with a better relationship to our office after having seen the specialist.
10    9    8    7    6    5    4    3    2    1   
16) Patients are more prepared to complete our recommended treatment after having been seen by a periodontist.
10    9    8    7    6    5    4    3    2    1   
COMMENT: Describe good or bad experiences.
FINAL COMMENTS:
What prompts you to refer a patient to your primary periodontist?
What factors cause you to refer to another periodontist?
I'd like to know how onPARC survey/assessment services can help me expand my practice.
Yes   
No   
If 'Yes' above, please enter an e-mail address or phone number:





 


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