Back To Patient Center Please enable JavaScript in your browser to complete this form. - Step 1 of 7Provider's Name *Provider's NameDr. BahramiDr. DesaiDr. ChoDr. ModiDr. ShoreDr. JonesDr. MudunuruDr. MadaniDr. KhanDr. ReddycherlaTracy Shah, N.P.Hilary Duke, N.P.Ki Cho, N.P.Grayson Loveless, N.P.Office Location *LocationNCG AtlantaNCG FayetteNCG Camp CreekNCG NewnanNCG ConyersDialysis UnitDear NCG Patient: You recently visited one of our clinics. We really appreciate you completing this survey about our practice. This information is confidential and will not be shared with anyone. Providing your name is optional.NextA. YOUR APPOINTMENT:1. Ease of making appointments *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 52. Getting care as soon as you wanted it *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 53. The efficiency of the check in process *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 54. Waiting time in the reception area *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 55. Waiting time in the exam room *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5PreviousNextB. OUR STAFF:1. Courtesy of our scheduling staff *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 52. Courtesy of our reception staff *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Caring, concern and professionalism 5 of our Medical Assistants *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5 4. The helpfulness of the people who assisted 5 you with billing and insurance *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5PreviousNextC. OUR COMMUNICATION:1. Getting advice/help during office hours *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 52. Explanation of your health condition *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 53. Test results reported in a reasonable time *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 54. Calls returned in a timely manner *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5PreviousNextD. YOUR VISIT WITH THE DOCTOR:1. Willingness to listen carefully and answer questions. *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 52. Amount of time spent with you *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 53. Explaining things in a way you could understand. *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 54. Courtesy/professionalism of the provider *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5PreviousNextE. YOUR OVERALL SATISFACTION WITH:1. Our practice *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 52. The quality of medical care you received *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 53. Overall rating of care from your provider *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5PreviousNextWOULD YOU RECOMMEND OUR PRACTICE TO OTHERS? *YesNoAdditional Comments:Gender *MaleFemaleYour Age *Under 1818 – 3031 – 4041 – 5051 – 60Over 60Are You *A new patientA returning patientWe appreciate your time. Thank You!Patient Name: *FirstLastSubmit
