Tricare Beneficiary Satisfaction Survey - LatinAmerica/Canada (web)

At the medical/dental facility, care was received within 30 minutes of appointment time.

The facility was clean and comfortable.

The doctor and professional staff were professional and courteous.

The doctor and professional staff spoke English.

To Help us serve you better, please complete the Customer Satisfaction Survey after you have received services from International SOS or any of the Network Providers. Your feedback is valuable in helping us improve the quality of service you receive.

Email Address

Name: (Optional)

Gender:

	Male
	Female

Age (years):

Status:

	Active Duty
	Active Duty Family Member
	Other

Location:

Country
City

Date of Care:

Was your medical requirement:

	Emergency care
	Routine care
	Dental
	Other

The care was provided by a:

	Hospital
	Clinic

Your principal care was provided by a:

	General Practitioner
	Family Practitioner
	Pediatrician
	Internist
	Obstetrician/Gynecologist
	Dentist
	Specialist/Other:

If you received care at a hospital or clinic:

Name of facility

Please select your overall rating of the facility and the quality of your care:

Excellent	Very Good	Good	Fair	Poor

Name of Doctor:

And you would rate the quality of care from this provider as:

Excellent	Very Good	Good	Fair	Poor

Please rate the following statements

You were satisfied with the care you received:

Agree Strongly	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable

Services were provided on a "cashless" basis:

Yes	No

Was your call to the SOS Call Center answered promptly?

Yes	No

My impression of the SOS Call Center was:

Excellent	Very Good	Good	Fair	Poor

Additional comments:

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