Patient Feedback Form

Which cancer center were you seen at for your radiation treatments?
Patient Feedback Form

At Northeastern Oklahoma Cancer Institute - Claremore your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Peninsula Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Southeast Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Mat-Su Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Anchorage Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Overall Satisfaction
The waiting room and treatment rooms were clean
My doctor spent adequate time with me & answered questions or concerns that I had
Radiation therapists were caring & attentive to my needs
If you had billing questions you received open and transparent financial counseling
Overall, I was satisfied with the care that I received

Overall satisfaction

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	N/A
The waiting room & treatment rooms were clean
My doctor spent adequate time with me & answered questions or concerns that I had
Radiation therapists were caring & attentive to my needs
I received open & transparent financial counseling
Overall, I was satisfied with the care that I received

What was the most meaningful experience provided by our team that showed you we understood & cared about you and your treatment?
To improve our quality of service, is there anything we could do better or differently?
Are there any comments you would like to share?
What additional services could we add that would be valuable to you? (check all that apply)

Other
Were you offered or aware that we have the following services available? (check all that apply)
What additional services could we provide that would be valuable to you?
What influenced your decision to choose our center (check all that apply)

Other
If you would you like to write a quote for our website please put it below and be sure to add your first name and city of residence in the boxes below.
First Name
City of Residence
Would you recommend our center to a family or friend?
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Please give us your first name and last initial to use with your feedback in future marketing materials

First NameLast Initial
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Name

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Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Overall Satisfaction