Medical Review Procedure Feedback Form
Please provide your feedback on the medical review procedure. Your responses will help us improve our process. This form is for general feedback only and does not collect sensitive health information.
Your role or relationship to the procedure
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Please Select
Patient
Family Member
Referring Physician
Medical Staff
Other
Date of procedure reviewed
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-
Month
-
Day
Year
Date
How satisfied were you with the overall review procedure?
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1
2
3
4
5
How clear was the communication throughout the review process?
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Not clear
1
2
3
4
Very clear
5
1 is Not clear, 5 is Very clear
How professional did you find the staff involved in the review?
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Not professional
1
2
3
4
Very professional
5
1 is Not professional, 5 is Very professional
How timely was the review process?
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Very slow
1
2
3
4
Very timely
5
1 is Very slow, 5 is Very timely
What aspects of the review procedure worked well?
What could be improved in the review procedure?
Would you recommend this review procedure to others?
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Yes
No
Not sure
Additional comments or suggestions
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