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About
Blog
FAQ
For Patients
For Physicians
Order Form
Disorders
CPAP
Order Supplies
Auto Resupply
Forms
Registration
Berlin Questionnaire
Epworth Sleepiness Scale
Satisfaction Survey
Contact
Pay
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(402) 486-3410
Satisfaction Survey
Fill Out The Satisfaction Survey Below
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We'd Love to Hear From You! Thank you for your recent visit to our sleep center for an overnight study. We strive to provide SAFE, HIGH QUALITY CARE at every opportunity. To that end, we hope you will help us by providing some feedback. We use your comments to continually improve our performance at our facility and with our patient care. We would appreciate if you took a few minutes and fill out this survey below. Your responses are confidential. Please let us know if you would like a call for us to address any concerns directly.
My questions regarding the appointment were answered completely and accurately.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
I received the written instructions for my appointment in a timely fashion.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
My questions regarding insurance coverage for sleep study services were answered to my satisfaction.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
The sleep center location was easy to find.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
My sleep technologist(s) was/were professional and courteous.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
My sleep technologist(s) explained the sleep study preparation and test to my satisfaction.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
The bedroom temperature and ventilation were acceptable.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
The bedroom at the sleep center was quiet and I was able to sleep without disruption due to outside noises.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
The sleep center was clean, including my bedroom and the bathroom(s).
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
My test results were received in the expected amount of time.
1 (Strongly Agree)
2
3 (Neutral)
4
5 (Strongly Disagree)
How you heard about Somnos Sleep Disorder Center?
Friend or family member
Physician/Nurse
Website/Internet Search
Television
Radio
Newspaper
Don’t Recall
As required by the State of Nebraska health clinic regulations, we are required to track any known or suspected cases of infection acquired at our facility. Within three days of your stay with us, did you experience any illness?
Don’t Recall
No
Yes (Please describe)
Describe Illness (if so)
We would appreciate any additional comments or suggestions you may have:
Would you like a phone call from our staff?
Yes
No
Name (optional):
First
Last
Phone (optional):
What is 6 + 1?
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