In an effort to ensure quality patient care, we would appreciate your time to answer the following questions. Please be forthright and honest so that we can continue areas of strength and improve areas of weakness.
When calling our office, was the staff friendly and helpful?

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* 1. When calling our office, was the staff friendly and helpful?

Did you receive instructions regarding location and appt info?

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* 2. Did you receive instructions regarding location and appt info?

Were you notified of your financial responsibility prior to scheduling your study?

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* 3. Were you notified of your financial responsibility prior to scheduling your study?

Did you feel safe coming to our office? If No, why?

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* 4. Did you feel safe coming to our office? If No, why?

Were you told by your physician why you were coming to our facility?

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* 5. Were you told by your physician why you were coming to our facility?

Please rate our physical facilites based on the following, if applicable:

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* 6. Please rate our physical facilites based on the following, if applicable:

  Excellent Good Fair Poor N/A
Facility decor
Restroom facilities
Bedroom comfort
Cleanliness
Temperature
Please rate our office staff based on the following, if applicable:

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* 7. Please rate our office staff based on the following, if applicable:

  Excellent Good Fair Poor N/A
Knowledge of office staff
Promptness to fulfill needs
Willingness to assist you
Knowledge of technical staff
Please rate our office procedures based on the following, if applicable:

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* 8. Please rate our office procedures based on the following, if applicable:

  Excellent Good Fair Poor N/A
Scheduling procedures
Technical staff's set-up procedures
Clinical staff's CPAP demo/explanation
Electrode removal/clean-up after PSG
Overall how satisfied were you with the care received at our facility?
Please list any additional comments regarding staff, facility or procedures. We welcome suggstions for improvements.

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* 9. Please list any additional comments regarding staff, facility or procedures. We welcome suggstions for improvements.

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* 10. Please enter the information below (optional)

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