We value your partnership and appreciate your referrals. 

 

As part of our commitment to continually improve our referral process and better serve your needs, we would appreciate your feedback to a few questions. 

 

The purpose of this survey is to assess our referral process and identify areas where we can improve.  

The survey should take no more than 5 minutes to complete  

Which title best describes your position? 
Physician
Nurse
Physician Assistant
Registered nurse
Medical assistant
Referral coordinator
Front desk staff
Case manager
Social worker
What is your medical specialty?
To which areas do you typically refer a patient to?
Select all that apply
Lab
Imaging
Medical Specialty
Surgery
Which referral pathways do you currently use?
Select all that apply
Fax
Email
Phone
Health Connect
Online Referral Form
EMR to EMR
Please select your top three preferred referral pathways
(1 is most preferred)
-
Fax
-
Email
-
Phone
-
Health Connect
-
Online Referral Form
-
EMR to EMR
-
Please select your top three preferred referral pathways:
How often do you refer patients to Vanderbilt Health? 
Always (daily or multiple times a week)
Often (a few times a week)
Sometimes (a few times a month)
Rarely (Once a month or less)
Never (no referrals in 6+ months)
How would you rate your experience referring a patient to us? 
Excellent
Good
Neutral
Needs Improvement
Very Poor
How satisfied are you with the communication regarding your referred patients? 
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Are there specific areas where you believe we could improve the referral process?
Select all that apply
Finding appropriate provider to refer patient to
Scheduling of patient
Verification that patient has been scheduled
Provider-to-Provider communication regarding patient
Is there anything else you would like to share about your referral experience?
Would you be interested in joining an online advisory council where you will have an opportunity to provide feedback and receive regular updates on improvements to our processes, including how you refer your patients to us?
If yes, please provide your email address / NPI #
Email Address
NPI Number
Thank you again for your participation in this survey. We are committed to using your feedback to improve our referral process and strengthen our partnership with you. We appreciate your continued trust and look forward to our ongoing collaboration. 
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