TCPC SURVEY: Please answer all questions as best as you can. Thank you for participating!
1. What are your expectations when sending patients to TCPC ?

2. Do you receive patient documentation/notes in a timely manner?
   NA…no patients referred at this time

3. If you don't schedule your patient's directly, do you want to be notified of your patient’s appointment date with TCPC after it     has been set up?
   NA…no patients referred at this time

4. How do you feel TCPC is meeting the needs of your patients?
   a. Exceeds expectations
   b. Meets Expectations
   c. Does not meet expectations
   d. NA not currently referring


5. Are you satisfied with the level of customer service related to the followings:
Yes No NA not currently referring
a. Ease of Scheduling

b. Cooperation/ of TCPC office staff

c. Prompt response to requests for information


6. Are your patients satisfied with their care/customer service related to followings:
Yes No NA not currently referring
a. Ease of scheduling

b. Wait times

c. Office environment

d. Expectation/explanation of appointment

e. Attentiveness of physician

f. Care provided by nursing staff


7. Do you utilize physical and behavioral therapy services provided by TCPC?
Yes No  
Physical Therapy

Behavioral Health


8. Would you like more information on TCPC: Check all that apply
   TCPC appointment pads
   TCPC online/fax referral forms
   TCPC Diagnosis and Treatment Sheet
   Office visit from Physician/CC/PA
   Information on how to obtain pain CEU credits for your staff

   Your office contact name, e-mail or phone# if you would like additional information
9. Final comments on how we can improve our service:

10. Your office specialty (ex: family, etc...)