Member Satisfaction Survey - Referral Process

St Vincent IPA is interested in receiving our patient's feedback. Listed below are a few simple questions that we would like you to respond to. Please respond to the appropriate questions and use the button at the bottom of the screen to submit your survey. Your response to this questionnaire will assist us in monitoring and improving the care our patient's receive.

*Primary Care Physician:
*Gender:	Male Female
*Age:
Member ID#:	(Optional)

1. How long have you been continuously enrolled with St Vincent IPA?
2. How many times have you seen your primary care physician in the last twelve (12) months?
3. How many times have you been referred by your primary care physician to a specialist in the last twelve (12) months?
If you have answered questions 2 and 3 as "None," please proceed to the end of the survey and submit your responses.
4. Please rate your experience in obtaining a referral to a specialist within the IPA.
Excellent Good Fair Poor No Experience
5. Once you were referred to a specialist from your primary care physician, how satisfied were you with the notification of your referral?
Excellent Good Fair Poor No Experience

We want to hear from you - Contact us @ 1-888-255-5053, ext. 109 or click here to send questions, comments and request more information