Referring Manager Questionnaire

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As part of Caer Health Services commitment to providing a quality service to you, we would be very grateful if you could take a few minutes to answer the brief questionnaire below regarding the service you received.

We would value your feedback to ensure that not only are we meeting your expectations, but if you do have any concerns or queries we can then address them and continually improve our service offering.

This information will also form part of an audit of the clinician and will be included in their professional development programme.

Many Thanks.
Caer Health Team.

Your Company Name:

Name of employee you referred:

Which clinician wrote the report:

How would you rate our referral process?
Very goodGoodPoorVery Poor

Did the report answer all the questions you asked on the referral form?
YesNo

How would you rate the report content and advice given?
Very goodGoodPoorVery Poor

Did the report help assist you in managing the case?
YesNo

Overall how satisfied were you with the service you received?
Very satisfiedSatisfiedUnsatisfiedVery unsatisfied

Is there anything Caer Health can do to improve the service we provided? Do you have any feedback?