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Contact Information
Facility Name : 
Name : 
Phone : 
 
 
Overall, how satisfied are you with the following:
Excellent Good Fair Poor
PACS Physician(s)
PACS NP/PA
PACS Admin
 
 
How would you rate the Medical Director
Excellent Good Fair Poor
Attends and participates in the Q/A meetings
Participates in development & presentation of education programs for staff & patients
Helpful with implementing resident care policies
Act as liaison between facility and PACS providers
 
 
 
Comments/Suggestions:
   
 
 
How would you rate PACS Physician(s) 
Excellent Good Fair Poor
Professionalism
Listens and responds appropriately
Friendly and helpful to you
Answers your questions
Responds timely when On-Call
Arrives on time according to calendar
Has supplies needed for the day
 
 
 
Comments/Suggestions:
   
 
 
How would you rate PACS Mid-Levels (NP, PA)
Excellent Good Fair Poor
Professionalism
Listens and responds appropriately
Friendly and helpful to you
Answers your questions
Responds timely when On-Call
Arrives on time according to calendar
Has supplies needed for the day
 
 
 
Comments/Suggestions:
   
 
 
How would you rate PACS Admin Team
Excellent Good Fair Poor
Professionalism
Listens and responds appropriately
Friendly and helpful to you
Answers your questions
Responds timely to calls or emails
 
 
 
Comments/Suggestions: