Home
Ways We Help
Child Adolescent and Adult Psychiatry
Psychological Services
Virtual Care Anytime
Patient Resources
Insurance
Common Questions Answered
Our Doctors
join our team
Privacy Policy
About Us
Psychiatry Residency Program
Get in Touch
Appointment
Search for:
Provider evaluation form
Home
Provider evaluation form
Please enable JavaScript in your browser to complete this form.
Date / Time
Date
Time
Provider name
Patient ID
Transcriptionist name
Average Handling Time in minutes
Punctuality
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Courteousness
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Active listening
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Allied healthcare services recommendations
Fast Pill pharmacy
Ketamine therapy
Partial teen program
Group therapy
Schedule follow ups
Yes
No
Submit