template for docTan

You can send in your comments and suggestions anonymously or let us know who you are. In either case we take all comments seriously and strive for continuous improvement in our practice.

Please indicate your responses below by selecting one of the options for each question. If a question does not apply to you or you wish not to respond to a particular item, please leave it blank. There is opportunity to provide additional written comments at the end of this survey.

Please rate our performance during your recent visit:

1=Very Dissatisfied ... 5=Very Satisfied	1	2	3	4	5
Did we greet you promptly ?
Were we courteous and professional?
Did we show consideration for your time?
Was our staff groomed and dressed appropriately?
Were our facilities clean (waiting, exam & bathrooms)?
Did we listen to, understand and answer your medical questions clearly?
Did we provide a clear explanation of your Diagnosis and Treatment?

Please rate our communications with you:

1=Never 2=Sometimes 3=Usually 4=Often 5=Always	1	2	3	4	5
- General Communications -
Our communications are professional, courteous, responsive?
We respond to your requests for prescription refills in the expected amount of time?
We call you with information and results within the expected amount of time?
You call us for information and results that are beyond the expected amount of time?
We answer your administrative questions immediately?
We provide answers to administrative questions in a timely fashion?
- Office Hours Telephone -
a person answers the phone?
An answering machine asks you to leave a message?
The phone lines are busy?
On hold, someone responds in an acceptable period of time?
Your messages are returned promptly?
- Closed Hours Telephone -
An answering service answers the phone?
An answering machine asks you to leave a message?
When needed, you are referred to an on-call physician?

Please rate our general accessibility:

1=Never 2=Sometimes 3=Usually 4=Often 5=Always	1	2	3	4	5
Our office hours reasonably meet your needs?
You can readily make an appointment at a mutually acceptable time and within a few days?
If we need to reschedule - you are notified in a reasonable amount of time?
If you need to reschedule - we are accommodating where possible?
When you arrive for an appointment we are ready?
We provide or arrange for immediate access in critical situations?
During Off hours - Dr. Tanenbaum or the on-call physician responds promptly?

Your Overall Rating:

1=Disagree+ 2=Disagree 3=Neutral 4=Agree 5= Agree+	1	2	3	4	5
Based on my experience I am satisfied with the services provided by Dr. Tanenbaum's practice.
Based on my experience I would recommend Dr. Tanenbaum's practice to relatives or friends.

On-line Communications:

This web site is provided for your reference and convenience. Further, we are considering adding on-line secure communications to this site. Since you have Internet access, please respond to the following about interacting with us further over secure connections. See our online page for more information. Please provide any additional comments below.

1=Don't Know 2=No 3=Maybe 4=Probably 5=Yes	1	2	3	4	5
Is this web site useful to you in its current state?
Have you or are you using the printable forms on this site?
If yes, do you find them useful and convenient?
Do you purchase products or make financial transactions over high security connections on the Internet?
Would you be willing to send personal medical information over high security Internet connections?
If not already set up, would you be willing to spend a few minutes to set up your computer for high security connections?
When we make secure forms transmissions and other services available will you tend to communicate with us on-line?

Additional Comments: Please provide any additional general comments on our practice that you may have:

WARNING! We do NOT respond to individual survey submittals. Do not include personal or sensitive medical information in this form. If you have a medical question or this is a medical emergency call us at (303) 776-7300 or call emergency medical services.

To assist us in evaluating your response, please answer the following?

How long have you been with Dr. Tanenbaum?

Years

On average, how many times per year do you see Dr. Tanenbaum?

If you see Dr. Tanenbaum less than once per year, approximately how many times total have you seen him?

Optional:

Your Name:

Thank you for your response:

Click on "Format" to review and print your completed form. If you need to make changes use your browser's "Back" button to return here.

The "Reset" button clears all form data. All information will be lost.

P7 MenuMagic dwt Control Layer -Do Not Alter