Information for Referring Physicians

Referring Physician Survey

As part of our continuing practice improvement, we value your opinion regarding our ability to meet your needs. To help us better serve you, please complete this confidential online survey. Your candid suggestions are welcome and will be kept confidential. Thank you for your input.

Physician Information

Please note that this survey may be completed anonymously; however, to receive a response from the Department of Radiology, you must include an e-mail address.

Physician to whom survey applies (optional).
E-mail address (optional).

Your Referral Patterns

Do you currently refer patients to our practice?
If yes, please check the office(s) to which you regularly refer:
Main Hospital, Third Floor
Gateway Building, Second Floor and Basement
Ambulatory Care Center, Lower Level
Stony Point, First and Second Floors
Nelson Clinic, Third Floor
Emergency Department
What percentage of your patient referrals is made to our practice?
Have you made any changes in your referrals to our practice in the past year?
If you have changed your referral patterns to our practice, what caused you to change?

If you currently refer patients to us, please rate our practice in the following areas.

Our ability to offer your patient a timely appointment.
Our willingness to see urgent cases on short notice.
The clinical skills of our physicians.
The timeliness of patient status reports.
The thoroughness of patient status reports.
Your patients’ comments about our practice.
The health plans we have contracted with.
The courtesy and responsiveness of our office staff.
The location of our office(s).
Your involvement in follow-up care.
Our process for returning your patient to your care.
If you have indicated a fair or poor rating, please tell us why.
What is your overall satisfaction with our practice?
What forms of communication do you prefer during patient treatment?
Personal phone calls from our physician.
Phone calls from a member of our staff.
Timely letters.
Fax.
E-mail.
Other (please specify)
Would you refer a member of your family to every one of our physicians?
If no, please tell us why.
How can we improve our services to you and your patients?

Other Comments

Please note the office to which they apply:

VCU Department of Radiology Virginia Commonwealth University VCU Medical Center