Referring Provider Survey
1.
Our allergy, asthma and immunologist specialists focus on comprehensive care for patients with allergies, asthma and other related conditions. Which of the following conditions do you typically choose to partner with us on?


Allergic Rhinitis
Asthma
Atopic Dermatitis
Chronic Urticaria
Drug Allergy
Eosinophilic Esophagitis
Food Allergies
Immunotherapy
Primary Immune Deficiency
Sinusitis
Stinging Insect
2.
As a partner in your patients allergic, asthmatic and other related conditions, how satisfied are you with us as a specialist to which you refer patients?

Completely Satisfied Mostly Satisfied Somewhat Satisfied Not Satisfied        
       
3.
Immunotherapy has shown to be effective in 85-90% of allergic patients when administered properly.  How beneficial do you believe allergy shots have been for your patients who receive them from us?

Completely Satisfied Mostly Satisfied Somewhat Satisfied Not Satisfied        
       
4.
Family Allergy & Asthma publishes a newsletter to keep Primary Care Providers updated on topics that may concern you and your patients.  What topics would you like to see covered in this newsletter?

 

350 characters left.
5.
Our providers are always willing to visit during lunch to discuss our patient care practices, new protocols and/or therapies or your specific needs from our practice.  Would you be interested in scheduling a "lunch and learn" session with one of our providers?

Yes
No, not at this time
6.
If you would like to schedule a Lunch and Learn Session, please provide your contact information: 

 

 

50 characters left.
7.
In what ways could we improve?
 

350 characters left.
8.
Any additional comments or feedback?
 

1000 characters left.
9.
If you would like to share your contact information, please enter it below and a Physician Services Managers will follow up with your comments. 

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com