Referring Veterinarian Referral Survey

Referring Veterinarian Survey

From (RDVM Email): *
Subject
What type of case did you refer? *	Companion Animal Food Animal Equine
What service did you refer your client to? *	Critical Care/Emergency Dermatology Internal Medicine Surgery Orthapaedics Neurology Ophthalmology Community Outpatient Oncology
Referring Veterinarian's First Name *
Referring Veterinarian's Last Name *
What is the first and last name of the client you referred? *
GENERAL SATISFACTION
What is the name of the faculty clinician to which this case was assigned?
Please rate the overall medical service (doctor and student) provided to your client?	Outstanding Good Adequate Needs Improvement Poor N/A
Please rate the overall service provided by our front office staff:	Outstanding Good Adequate Needs Improvement Poor N/A
REFERRAL PROCESS
How would you rate the convenience of our referral process?	Outstanding Good Adequate Needs Improvement Poor N/A
If you used faxing or electronic referral, was this process completed easily?	Very Easy Somewhat Easy Adequate Somewhat Difficult Very Difficult
If applicable, how long did you wait to speak with a referral coordinator?	0-1 minute 1-2 minutes 3-4 minutes 4-5 minutes Greater than 5 minutes N/A
Please rate the staff person who facilitated your referral:	Outstanding Good Adequate Needs Improvement Poor (please consider their knowledge, courtesy and helpfulness)
CARE
Please rate the timeliness and quality of communication with our faculty after your patient was admitted:	Outstanding Good Adequate Needs Improvement Poor N/A
Please rate the timeliness and quality of patient status updates during hospitalization:	Outstanding Good Adequate Needs Improvement Poor N/A
How do you rate the availability of the doctor/service for ongoing consultation relative to your referred patient's care?	Outstanding Good Adequate Needs Improvement Poor N/A
Rate the demeanor of the doctor and service managing your client's case:	Outstanding Good Adequate Needs Improvement Poor N/A
How does your referral service/doctor rate in including you in the healthcare decisions regarding your patient?	Outstanding Good Adequate Needs Improvement Poor N/A
Please rate the overall competence of your referral service/doctor:	Outstanding Good Adequate Needs Improvement Poor N/A
Please rate the quality and timeliness of discharge instructions and follow-up information that was provided to you:	Outstanding Good Adequate Needs Improvement Poor N/A
Based on follow-up with your client, how do you think they would rate their experience at Auburn?	Outstanding Good Adequate Needs Improvement Poor N/A
Please rate the value that the clients you refer to the hospital receive for their investment:	Outstanding Good Adequate Needs Improvement Poor N/A
Are you willing to refer additional clients to the Auburn University Veterinary Teaching Hospital?	Yes No
If you could list one area where we need improvement, what would it be?
How recent was your last referral? *	Within the last two weeks Within the last month Within the last quarter Within the last year More than a year
Please list your preference for receiving communication from us ( discharge summaries, notifications, ect.) in the future. We will not make any changes unless you are first notified.	Email Fax
Would you be willing to complete a short (2-3 minute) online quality survey after each of your patients is discharged? *	Yes No Maybe
General Comments:
Verify Your Humanity