Evaluation of AOM Services

Please help us improve our service by taking a moment to complete this survey.


Please, fill out evaluation form below


This question is required
  1. How would you rate the office staff’s helpfulness, professionalism and accuracy?

Poor
Below Average
Average
Above Average
Excellent

  1. How well have our medical providers communicated with you regarding injured worker status and progression of cases or physical exam results?

  2. ( Optional )
PoorBelow AverageAverageAbove AverageExcellent
Tom Zdimal, PA
Edward Cooper, MD
Maria Bolinao Braren, NP
Samir Sharma, MD
Jaishree Acharya, MD
Sapna Sheth Rajput, DO
James Petros, MD
Basil R. Besh, MD

  1. How would you rate the quality and helpfulness of our rehabilitation department?

  2. ( Optional )
PoorBelow Average Average Above Average Excellent
Val Kshirsagar, PT
Adam Wong, DC
Monisha Chanan, DC
Richard Esquivel, DNBAO, QME
Christopher Darden, PTA
Aivaras Sajus, PT

  1. How would you rate the quality and helpfulness of our billing department?

  2. ( Optional )
Poor
Below Average
Average
Above Average
Excellent

This question is required
  1. How would you rate your overall satisfaction with the services at Alliance Occupational Medicine?

Poor
Below Average
Average
Above Average
Excellent

  1. What could we do in the future to improve the services at our medical facility?

  2. ( Optional )

  1. Please, state your name and organzation (example: John Smith, ZYX, Inc.)
  2. ( Optional )

  1. Would you like us to contact you for additional feedback? If yes, pelease indicate below the best phone number we can reach you at.
  2. ( Optional )



Thank you for your comments and continued business with us!



Our Customers Say ...

Our Patients Say...

Dr. Cooper, Paulette, Anna, Steve, Adina, Triana ~ All of the above are so good! They work so well together &are very caring. Great people to deal with! Very professional.
M. G.
Steve ~ has a very good personality. Drew my blood painlessly and efficient. A great employee; very calming.
S. S.
Steve ~ Always friendly, personable & such a pleasant addition to the office. He is thorough, yet prompt & seemed to learn his job fast & well. Keep him on!
M.
Val ~ in Physical Therapy is very caring, kind, friendly and is concerned about the well being of her patient. She is courteous all the time and most of all, knowledgeable about her job.
J.M.
Adina ~ Very helpful. Always knows what is going on. Very polite
A. S.
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