Kevin Lunde, MD Patient Consultation Survey

1. Kevin Lunde, MD Plastic Surgery Consultation Survey

Please answer the survey questions. Additional comments may be written at the end. Consider “what was good” about your visit and “what could be better.”

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* 1. How satisfied are you with:

	Satisfied	Highly Satisfied	NA	Somewhat Satisfied	Somewhat Dissatisfied	Dissatisfied	Highly Dissatisfied
The sign-in process.	The sign-in process. Satisfied	The sign-in process. Highly Satisfied	The sign-in process. NA	The sign-in process. Somewhat Satisfied	The sign-in process. Somewhat Dissatisfied	The sign-in process. Dissatisfied	The sign-in process. Highly Dissatisfied
The timeliness of your appointment.	The timeliness of your appointment. Satisfied	The timeliness of your appointment. Highly Satisfied	The timeliness of your appointment. NA	The timeliness of your appointment. Somewhat Satisfied	The timeliness of your appointment. Somewhat Dissatisfied	The timeliness of your appointment. Dissatisfied	The timeliness of your appointment. Highly Dissatisfied
The way information was shared with you.	The way information was shared with you. Satisfied	The way information was shared with you. Highly Satisfied	The way information was shared with you. NA	The way information was shared with you. Somewhat Satisfied	The way information was shared with you. Somewhat Dissatisfied	The way information was shared with you. Dissatisfied	The way information was shared with you. Highly Dissatisfied
The overall care given by the staff.	The overall care given by the staff. Satisfied	The overall care given by the staff. Highly Satisfied	The overall care given by the staff. NA	The overall care given by the staff. Somewhat Satisfied	The overall care given by the staff. Somewhat Dissatisfied	The overall care given by the staff. Dissatisfied	The overall care given by the staff. Highly Dissatisfied
The overall care given by the doctor.	The overall care given by the doctor. Satisfied	The overall care given by the doctor. Highly Satisfied	The overall care given by the doctor. NA	The overall care given by the doctor. Somewhat Satisfied	The overall care given by the doctor. Somewhat Dissatisfied	The overall care given by the doctor. Dissatisfied	The overall care given by the doctor. Highly Dissatisfied

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* 2. How much do you agree with the following?

	Strongly Disagree	Disagree	Somewhat Disagree	Somewhat Agree	Agree	Strongly Agree	NA
The doctor treated me with respect.	The doctor treated me with respect. Strongly Disagree	The doctor treated me with respect. Disagree	The doctor treated me with respect. Somewhat Disagree	The doctor treated me with respect. Somewhat Agree	The doctor treated me with respect. Agree	The doctor treated me with respect. Strongly Agree	The doctor treated me with respect. NA
The doctor listened to me.	The doctor listened to me. Strongly Disagree	The doctor listened to me. Disagree	The doctor listened to me. Somewhat Disagree	The doctor listened to me. Somewhat Agree	The doctor listened to me. Agree	The doctor listened to me. Strongly Agree	The doctor listened to me. NA
The doctor seemed to care about my feelings.	The doctor seemed to care about my feelings. Strongly Disagree	The doctor seemed to care about my feelings. Disagree	The doctor seemed to care about my feelings. Somewhat Disagree	The doctor seemed to care about my feelings. Somewhat Agree	The doctor seemed to care about my feelings. Agree	The doctor seemed to care about my feelings. Strongly Agree	The doctor seemed to care about my feelings. NA
The doctor and staff worked well as a team.	The doctor and staff worked well as a team. Strongly Disagree	The doctor and staff worked well as a team. Disagree	The doctor and staff worked well as a team. Somewhat Disagree	The doctor and staff worked well as a team. Somewhat Agree	The doctor and staff worked well as a team. Agree	The doctor and staff worked well as a team. Strongly Agree	The doctor and staff worked well as a team. NA
The doctor told me all I needed to know.	The doctor told me all I needed to know. Strongly Disagree	The doctor told me all I needed to know. Disagree	The doctor told me all I needed to know. Somewhat Disagree	The doctor told me all I needed to know. Somewhat Agree	The doctor told me all I needed to know. Agree	The doctor told me all I needed to know. Strongly Agree	The doctor told me all I needed to know. NA
The staff helped me when I needed help.	The staff helped me when I needed help. Strongly Disagree	The staff helped me when I needed help. Disagree	The staff helped me when I needed help. Somewhat Disagree	The staff helped me when I needed help. Somewhat Agree	The staff helped me when I needed help. Agree	The staff helped me when I needed help. Strongly Agree	The staff helped me when I needed help. NA
I felt comfortable asking questions.	I felt comfortable asking questions. Strongly Disagree	I felt comfortable asking questions. Disagree	I felt comfortable asking questions. Somewhat Disagree	I felt comfortable asking questions. Somewhat Agree	I felt comfortable asking questions. Agree	I felt comfortable asking questions. Strongly Agree	I felt comfortable asking questions. NA
I was comfortable during the exam.	I was comfortable during the exam. Strongly Disagree	I was comfortable during the exam. Disagree	I was comfortable during the exam. Somewhat Disagree	I was comfortable during the exam. Somewhat Agree	I was comfortable during the exam. Agree	I was comfortable during the exam. Strongly Agree	I was comfortable during the exam. NA
I understand the proposed treatment plan.	I understand the proposed treatment plan. Strongly Disagree	I understand the proposed treatment plan. Disagree	I understand the proposed treatment plan. Somewhat Disagree	I understand the proposed treatment plan. Somewhat Agree	I understand the proposed treatment plan. Agree	I understand the proposed treatment plan. Strongly Agree	I understand the proposed treatment plan. NA
I know who to call if I have questions.	I know who to call if I have questions. Strongly Disagree	I know who to call if I have questions. Disagree	I know who to call if I have questions. Somewhat Disagree	I know who to call if I have questions. Somewhat Agree	I know who to call if I have questions. Agree	I know who to call if I have questions. Strongly Agree	I know who to call if I have questions. NA

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* 3. I would recommend Dr. Lunde to my loved ones and friends.

Yes

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* 4. I would return to Dr. Lunde for other treatments.

Yes

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* 5. Optional Information - Gender

Male

Female

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* 6. I consulted with the doctor about:

Facial plastic surgery

Ear, nose or throat problems

Allergy treatments

Hearing loss or hearing aids

Other (please specify)

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* 7. Additional comments:

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* 8. Optional information - Your name

Thank you for your participation. Please click submit and your results will be sent to us directly. You will automatically be taken to our home page where you can learn more about our services.