Patient Feedback Form

Which cancer center were you seen at for your radiation treatments?*
Patient Feedback Form

At Eastern Oregon Cancer at Pendleton your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Northeastern Oklahoma Cancer Institute - Claremore your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Peninsula Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Southeast Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Mat-Su Valley Cancer Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Patient Feedback Form

At Anchorage Radiation Oncology Center your opinion is important to us. Please take a moment to complete this confidential survey. Your candid responses will help us continue to improve our service and ensure that we are practicing HOPE with every patient.
Overall Satisfaction
The waiting room and treatment rooms were clean*
My doctor spent adequate time with me & answered questions or concerns that I had*
Radiation therapists were caring & attentive to my needs*
If you had billing questions you received open and transparent financial counseling*
Overall, I was satisfied with the care that I received*

Overall satisfaction*

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	N/A
The waiting room & treatment rooms were clean
My doctor spent adequate time with me & answered questions or concerns that I had
Radiation therapists were caring & attentive to my needs
I received open & transparent financial counseling
Overall, I was satisfied with the care that I received

What was the most meaningful experience provided by our team that showed you we understood & cared about you and your treatment?
To improve our quality of service, is there anything we could do better or differently?
What additional services could we add that would be valuable to you? (check all that apply)*

NutritionistSocial WorkPersonal TrainingCancer Care NavigationCancer CoachingNoneOther
What influenced your decision to choose our center (check all that apply)*

Primary Care Physician (Family Dr)Family/Friend RecommendationAdvertisingSpecialist PhysicianProximity to CenterOther
Would you recommend our center to a family or friend?*

YesNo
Do you give us permission to use your feedback in future marketing materials using your first name and last initial?*

YesNoMay use feedback, but not name
Please give us your first name and last initial to use with your feedback in future marketing materials

First NameLast Initial
Do you want to be contacted about this survey?*

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Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Patient Feedback Form

Overall Satisfaction