Referral Source Satisfaction Questionnaire

2) How Is the Referral Process at Cross Creek Hospital Together With Ascension Seton?

• Excellent
• Good
• Average
• Poor

3) How would you rate the Customer Service at Cross Creek Hospital Together With Ascension Seton?

• Excellent
• Good
• Average
• Poor

4) Written and/or Verbal Clinical Communications from the staff are informative and helpful.

• Strongly Agree
• Agree
• Neutral
• Disagree
• Strongly Disagree

5) The Staff are helpful and professional?

• Yes
• No

6) Are your needs addressed when you contact Cross Creek Hospital Together With Ascension Seton?

• Yes
• No
• Other

7) My marketing representative keeps me informed in a professional manner

• Yes
• No

8) I would be willing to refer others your facility.

• Strongly Agree
• Agree
• Neutral
• Disagree
• Strongly Disagree

9) To What Other facilities do you refer patients to?

10) What could Cross Creek Hospital Together With Ascension Seton do differently so that you would refer patients to us instead of others?

11) How likely is it that you would recommend Cross Creek Hospital Together With Ascension Seton to a friend or colleague?

• Very Likely
• Likely
• Neutral
• Unlikely
• Highly Unlikely

12) If you would like to be contacted to learn more about Cross Creek Hospital Together With Ascension Seton or to formally address your concerns, please enter your name, organization name, email, and phone number below.