Post Visit Survey

Please take a moment to answer the following questions by selecting the number that BEST matches your response:

1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

My call was answered quickly and efficiently by the EGMS Representative:
 1 2 3 4 5

EGMS Representative was courteous and friendly:
 1 2 3 4 5

My house call was scheduled at a convenient time:
 1 2 3 4 5

My Physician arrived on time:
 1 2 3 4 5

If my physician was delayed, I was notified:
 1 2 3 4 5

My physician was KIND & SYMPATHETIC:
 1 2 3 4 5

My physician acted in a professional manner:
 1 2 3 4 5

My physician provided treatment in a caring & pleasant manner:
 1 2 3 4 5

My physician explained the diagnosis and treatment to my satisfaction:
 1 2 3 4 5

I felt confident in the physician's recommendation regarding my treatment:
 1 2 3 4 5

The house call was a good VALUE for the services received:
 1 2 3 4 5

I would recommend this service to others:
 1 2 3 4 5

I consider this house call service important when making future hotel reservations:
 1 2 3 4 5

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Travel Assistance Company (If Applicable)

Tour Operator (If Applicable)

Vacation Home Company (If Applicable)

Hotel

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