Medical Staff Survey Form

Tomah Health’s Medical Staff Executive Committee is conducting a survey to evaluate the Medical Staff categories of Active, Courtesy, Consulting and Community Affiliate. The end goal is to design a system that engages as many providers as possible so that we ensure that the Medical Staff remains a vital and dynamic body serving the patients of Tomah Health.

We are also evaluating the date and time of the Medical Staff meetings. Currently, all active members of the Medical Staff meet quarterly on the 3rd Monday in January, April, July and October at 6:00 PM. We are requesting your input as to whether or not this date and time works for you.

Your responses are greatly appreciated.


"*" indicates required fields

1. How important is it to you to be an active voting Tomah Health staff member for:

a. Bylaws, Rules and Regulations?
b. Elections for Med Exec & Hospital Board membership?
c. Operations Decisions?
d. Future Planning?
2. How important is it for you to schedule surgeries and/or procedures at Tomah Health?
4. Should Associate Providers have the ability to become full active staff members with voting rights equal to physicians, or continue to have a separate staff category?
5. How important is it to you to refer your patients to Tomah Health for services?

6. Please check all the services that you use for your patients at Tomah Health.

Sleep Medicine:
Surgical Services:
ER / Urgent Care:
Wound Care:
Infusion Services:
Lab Services:
Imaging Services:
Rehab Services:
Cardiac Rehab
Women's Health
Inpatient Services:

7. The Medical Staff quarterly meetings are currently held on the 3rd Monday in January, April, July and October at 6:00 PM. Please select which date and time works best for you. *Note: The meetings could be attended via phone or Web Conference


Medical Staff Survey Form Submission


Tomah Health