Ambulatory EEG Test Patient Survey


Patient First Name: *
  
Patient Last Name: *
  
City: *
  
State: *
  
Please rate the level of service you received from DigiTrace's office personnel. (i.e. professionalism, attitude, attentiveness, helpfulness, etc.): *
  
Did we adequately explain each step of the procedure and the appropriate use of this system?: *
  
If not please explain.:
  
During your first appointment and set-up: Were you comfortable?: *
  
During your first appointment and set-up: Were all your questions answered?: *
  
During your first appointment and set-up: Were there any surprises?: *
  
Did you have any trouble with the system while outside of our office?: *
  
If so, what specifically?:
  
Relative to other medical office experiences, how would you rate your DigiTrace experience?: *
  
Why would you rate it this way?:
  
Did you feel sufficiently prepared for your monitoring period?: *
  
If no, please explain.:
  
Comments or Service/Safety Improvement Suggestions:
  
Testimonial:
  
If you had a good experience with our service, please provide your testimonial. We will publish only your testimonial, city, state and date of comment if used in our publications.
 
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