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Patient Surveyvalethealth2024-12-30T22:56:21+00:00

Patient Satisfaction Survey

Louisiana Pain Care is committed to providing the best in patient care. We appreciate knowing about your experience with us. Please complete and submit our anonymous patient satisfaction survey. Thank you in advance for your input.

Personal Information:
Are you:
- Established Patient
- New Patient
Office Visited:*
- Monroe Clinic
- Ruston Clinic
- ArkLaMiss Surgery Center
- Advanced Surgery Center of Northern Louisiana
- Glenwood Medical Center
- Northern Louisiana Medical Center – Ruston
- P & S Surgical Hospital
- St. Francis Medical Center
Date of Visit:
MM slash DD slash YYYY
Provider:*
- Dr. Ledbetter
- Dr. Forte
- Dr. Gordon
- Andy Austin, FNP, FAAPM
- Donna Courson, FNP
- Stephen "Chuck" Stansbury, FNP
- Mike Lofstrom, FNP
- Paul Roberts, FNP
- Bethany Scott, FNP
- Valerie Boyd, FNP
- Edie Lemley, FNP
How did you hear about us:
- Dr. Referral/Medical Provider
- Friend/Family
- Louisiana Pain Care Website
- Google, Yahoo, Bing, etc.
- Billboard
- Prior Experience
- Yellow Pages/Phone Book
- Attorney
- Radio
- Other
Other
Whom may we thank for your referral? (Name & Address):
Was there a staff member you would like to recognize?
Your Experience
How would you rate your overall experience with Louisiana Pain Care?
- Excellent
- Very Good
- Good
- Fair
- Poor
Please rate the following on a scale 1-5. With 5 being excellent. (5-Excellent 4-Very Good 3-Good 2- Fair 1-Poor)
I will likely recommend Louisiana Pain Care to a friend
- 5
- 4
- 3
- 2
- 1
Overall, my experience today was
- 5
- 4
- 3
- 2
- 1
Overall cleanliness of our office was
- 5
- 4
- 3
- 2
- 1
I was able to schedule my appointment within a reasonable amount of time
- 5
- 4
- 3
- 2
- 1
The phone staff was professional and friendly
- 5
- 4
- 3
- 2
- 1
The check-in staff was efficient and friendly
- 5
- 4
- 3
- 2
- 1
Receiving a reminder call or e-mail was helpful
- 5
- 4
- 3
- 2
- 1
I received care, concern, & respect from my provider
- 5
- 4
- 3
- 2
- 1
I received clear & complete communication from my provider
- 5
- 4
- 3
- 2
- 1
Length of time before being seen by provider
- 5
- 4
- 3
- 2
- 1
I found the Louisiana Pain Care website to be efficient & helpful
- 5
- 4
- 3
- 2
- 1
Would you like to receive statements by e-mail or regular mail?
- Yes
- No
Please comment on anything regarding our service that we might change to make the patient experience even more positive.
Did you experience any problems during recovery? If so, please comment:
Information below is optional; however, we would like to acknowledge that you spent the time to give us feedback. May we share your comments with others?
- Yes
- No
Name
First Last
Phone
Email

Louisiana Pain Care Spine Care Experts written in white over transparent background

Monroe

ArkLaMiss Surgery Center
210 Layton Avenue
Monroe, LA 71201

Ruston

1809 Northpointe Lane
Suite 101
Ruston, LA 71270

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