Physician Satisfaction Survey

You recently used the services of Mercy Nurse On Call. Please rate the services you received. Select the button that best represents your feelings. If you had no experience with a particular service or item, select N/A.

Thank you!

  Very poor Poor Good Very good N/A
Helpfulness of the nurse  
Accuracy of information given to patient  
Extent to which protocols are followed  
Appropriateness of dispositions  
Quality of follow-up information  
Overall quality of service  
Likelihood of recommending the service  

By using the Mercy Nurse Triage Service, the numbers of pages I am receiving has decreased by:
0-25% 25-50% 50-75% No decrease

Do your patients feel that they have adequate access to you?
Yes No

Are your patients satisfied with the service they are receiving from Nurse On Call?
Yes No

I would like to receive a phone call to discuss further.
Yes No

Physician name:
Phone number: