Front Range Survey

Please choose one that best describes you:

Intermountain Health Provider/Caregiver Non-Intermountain Health Provider/Caregiver

Please indicate your department/role:

ED Provider Urgent Care Provider Hospitalist Primary Care Clinic Specialty Clinic Hospital Caregiver/CM Walk-In Clinic

Overall, how would you rate your experience using SCLHealth/IH First Call patient transfer center?

Excellent Above Average Average Below Average Poor

Please rank your interactions with SCLHealth/IH First Call in the following categories.

Please rank your interactions with SCLHealth/IH First Call in the following categories.
	Excellent	Above Average	Average	Below Average	Poor
Efficiency during the referral intake process.	Please rank your interactions with SCLHealth/IH First Call in the following categories.: Efficiency during the referral intake process. (Excellent)	Efficiency during the referral intake process. (Above Average)	Efficiency during the referral intake process. (Average)	Efficiency during the referral intake process. (Below Average)	Efficiency during the referral intake process. (Poor)
Timeliness of patient acceptance.	Timeliness of patient acceptance. (Excellent)	Timeliness of patient acceptance. (Above Average)	Timeliness of patient acceptance. (Average)	Timeliness of patient acceptance. (Below Average)	Timeliness of patient acceptance. (Poor)
Communication with transfer status updates.	Communication with transfer status updates. (Excellent)	Communication with transfer status updates. (Above Average)	Communication with transfer status updates. (Average)	Communication with transfer status updates. (Below Average)	Communication with transfer status updates. (Poor)
Courteousness and professionalism of call center caregiver.	Courteousness and professionalism of call center caregiver. (Excellent)	Courteousness and professionalism of call center caregiver. (Above Average)	Courteousness and professionalism of call center caregiver. (Average)	Courteousness and professionalism of call center caregiver. (Below Average)	Courteousness and professionalism of call center caregiver. (Poor)

If you are a referring provider, how satisfied are you with the overall process and the accepting/consulting physician experience?

Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied N/A

If you are an accepting/consulting provider, how satisfied are you with the overall process and with connecting with the referring provider and facility

Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied N/A

Please share your feedback about your overall experience with our transfer service.

Submission Date

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Campaign Medium

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Campaign Name

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GCLID (Google Click Identifier)

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