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403-696-1020
info@cloudbreak.ca
#215, 3917 University Ave NW Calgary AB T3B 6K3
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
#215, 3917 University Ave NW Calgary AB T3B 6K3
#215, 3917 University Ave NW Calgary AB T3B 6K3
Southern Alberta
University District
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Southwest Calgary
Suite 315, 5340 1 St SW Calgary, AB T2H 0C8
University District
Suite 215, 3917 University Ave NW Calgary AB T3B 6K3
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
403-696-1020
info@cloudbreak.ca
#215, 3917 University Ave NW Calgary AB T3B 6K3
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Menu
About
Our Teams
Southwest Calgary Team
University District Team
Careers
Patients
Cataract
Glaucoma
Others
Prepare your First Visit
FAQ’s
Patient Form
Patient Survey
Referring Doctor
The Referral Process
Why Refer to Us?
Referral Form
Referring Doctor Survey
Research
Contact Us
Contact Southwest Calgary
Contact University District
Surveys
Referring Doctor Survey
Patient Survey
Blog
Referring Doctor Survey
Select Clinic Location
*
Southwest Calgary
Suite 315, 5340 1 St SW Calgary, AB T2H 0C8
T: 403-281- 0603 / F: 403-281-2471
E: info@cloudbreak.ca
University District
Suite 215, 3917 University Ave NW Calgary AB T3B 6K3
T: 403-696-1020 / F: 403-640-4047
E: ud@cloudbreak.ca
Referring Process
RadioAbility to easily obtain, complete and submit a patient referral form.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Timeliness of the communication you received about your patient’s initial appointment(s).
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Professionalism of our clinic staff.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Appropriate length of time your patient(s) had to wait for an appointment (adjusted relative to urgency).
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Efficiency of the current referral process at Cloudbreak Eye Care.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
What do you appreciate most about our referral process?
Is there something we could improve in our referral process?
Patient Care and Update Reports
Timeliness of updates you receive regarding your patient’s progress.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Quality and completeness of the updates you receive regarding your patient’s progress.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Overall quality of care your patients receive at Cloudbreak Eye Care.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Your patients’ feedback about their care/treatments at Cloudbreak Eye Care.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
Your patients’ feedback about the courtesy and responsiveness of our clinic staff.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
What do you appreciate most regarding the patient care and update reports provided by Cloudbreak Eye Care?
Is there something we could improve regarding the patient care and update reports provided by Cloudbreak Eye Care?
Overall Satisfaction
The feedback I have received from our mutual patients is positive.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
The feedback I have received from our mutual patients is positive.
*
Very Good
Good
Fair
Poor
Very Poor
N/A
My overall satisfaction with Cloudbreak Eye Care.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
Do you have any other comments or feedback you would like to share?
Contact Information (optional)
First Name
Last Name
Clinic/practice name
Phone
Email Address
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