Print    Email
Decrease (-) Restore Default Increase (+)

Surveys & Forms

Prostate Cancer Survey

Please take a moment to let us how we are doing. The opinions of our patents and their families help us provide Remarkable Medicine and Remarkable Care. Your responses are confidential and will be combined with those of other patients to help improve the health care services we provide.

* Indicates required information

Please provide the following information to help us best serve you.

First Name
Last Name
Email
Phone

1.
How do you rate your Prostate Cancer Multidiscipline Program experience?
2.
During your visit, the amount/quality of time spent with the urologist
3.
During your visit, the amount/quality of time spent with radiation
4.
Explanation of test results
5.
Explanation of your diagnosis and treatment (individual treatment)
6.
Full information shared with me, so I was able to make a treatment decision
7.
Availability of educational materials
8.
Reassurance and support offered
9.
Having a Nurse Navigator helped me through my process
10.
Overall, did the Prostate Cancer Multidisciplinary Program meet your needs?
11.
Office environment (cleanliness, comfort, lighting, temperature)
12.
Friendliness and courtesy by:
- Desk staff
- Urology office
- Radiation Oncology office
- Medical Staff
13.
Convenience of parking
14.
Comments:

Authentication *
If the challenge words are too difficult to read, click here to refresh.
 
A Member of Trinity Health
© 2014 Trinity Health

St. Joseph Mercy Ann Arbor | 5301 McAuley Drive, Ypsilanti, MI 48197 | 734-712-3456