Louisiana Pain Care is committed to providing the best in patient care. We appreciate knowing about your experience with us. Please complete and submit our anonymous patient satisfaction survey. Thank you in advance for your input. Personal Information:Are you:Established PatientNew PatientOffice Visited:* Monroe Clinic Ruston Clinic ArkLaMiss Surgery Center Advanced Surgery Center of Northern Louisiana Glenwood Medical Center Northern Louisiana Medical Center – Ruston P & S Surgical Hospital St. Francis Medical Center Date of Visit: Date Format: MM slash DD slash YYYY Provider:* Dr. Ledbetter Dr. Forte Dr. Gordon Dr. Ellis Andy Austin, FNP, FAAPM Donna Courson, FNP Stephen "Chuck" Stansbury, FNP Mike Lofstrom, FNP Paul Roberts, FNP Bethany Scott, FNP Valerie Boyd, FNP Edie Lemley, FNP How did you hear about us: Dr. Referral/Medical Provider Friend/Family Louisiana Pain Care Website Google, Yahoo, Bing, etc. Billboard Prior Experience Yellow Pages/Phone Book Attorney Radio Other OtherWhom may we thank for your referral? (Name & Address):Was there a staff member you would like to recognize?Your ExperienceHow would you rate your overall experience with Louisiana Pain Care?ExcellentVery GoodGoodFairPoorPlease rate the following on a scale 1-5. With 5 being excellent. (5-Excellent 4-Very Good 3-Good 2- Fair 1-Poor)I will likely recommend Louisiana Pain Care to a friend54321Overall, my experience today was54321Overall cleanliness of our office was54321I was able to schedule my appointment within a reasonable amount of time54321The phone staff was professional and friendly54321The check-in staff was efficient and friendly54321Receiving a reminder call or e-mail was helpful54321I received care, concern, & respect from my provider54321I received clear & complete communication from my provider54321Length of time before being seen by provider54321I found the Louisiana Pain Care website to be efficient & helpful54321Would you like to receive statements by e-mail or regular mail?YesNoPlease comment on anything regarding our service that we might change to make the patient experience even more positive.Did you experience any problems during recovery? If so, please comment:Information below is optional; however, we would like to acknowledge that you spent the time to give us feedback. May we share your comments with others?YesNoName First Last PhoneEmail
