Patient Satisfaction Survey

Please rate us on a scale of 1 to 5, with 5 being the highest level of satisfaction.

1. Appointment Process

	1	2	3	4	5	NA
Your ease in reaching a staff member to make first appointment	*Appointment Process Your ease in reaching a staff member to make first appointment 1	Your ease in reaching a staff member to make first appointment 2	Your ease in reaching a staff member to make first appointment 3	Your ease in reaching a staff member to make first appointment 4	Your ease in reaching a staff member to make first appointment 5	Your ease in reaching a staff member to make first appointment NA
Staff was friendly, professional and helpful	Staff was friendly, professional and helpful 1	Staff was friendly, professional and helpful 2	Staff was friendly, professional and helpful 3	Staff was friendly, professional and helpful 4	Staff was friendly, professional and helpful 5	Staff was friendly, professional and helpful NA
Made effort to accommodate your scheduling preferences	Made effort to accommodate your scheduling preferences 1	Made effort to accommodate your scheduling preferences 2	Made effort to accommodate your scheduling preferences 3	Made effort to accommodate your scheduling preferences 4	Made effort to accommodate your scheduling preferences 5	Made effort to accommodate your scheduling preferences NA

Other (please specify)

2. Hyperbaric Facility

	1	2	3	4	5	NA
Neat, clean and inviting	*Hyperbaric Facility Neat, clean and inviting 1	Neat, clean and inviting 2	Neat, clean and inviting 3	Neat, clean and inviting 4	Neat, clean and inviting 5	Neat, clean and inviting NA
Ease in accessing the clinic	Ease in accessing the clinic 1	Ease in accessing the clinic 2	Ease in accessing the clinic 3	Ease in accessing the clinic 4	Ease in accessing the clinic 5	Ease in accessing the clinic NA
Comfortable for you, family and/or friends during wait and treatment	Comfortable for you, family and/or friends during wait and treatment 1	Comfortable for you, family and/or friends during wait and treatment 2	Comfortable for you, family and/or friends during wait and treatment 3	Comfortable for you, family and/or friends during wait and treatment 4	Comfortable for you, family and/or friends during wait and treatment 5	Comfortable for you, family and/or friends during wait and treatment NA
Appreciated DVDs and literature available for entertainment	Appreciated DVDs and literature available for entertainment 1	Appreciated DVDs and literature available for entertainment 2	Appreciated DVDs and literature available for entertainment 3	Appreciated DVDs and literature available for entertainment 4	Appreciated DVDs and literature available for entertainment 5	Appreciated DVDs and literature available for entertainment NA

Other (please specify)

3. Hyperbaric Staff

	1	2	3	4	5	NA
Greeted, welcomed and acknowledged you upon arrival	*Hyperbaric Staff Greeted, welcomed and acknowledged you upon arrival 1	Greeted, welcomed and acknowledged you upon arrival 2	Greeted, welcomed and acknowledged you upon arrival 3	Greeted, welcomed and acknowledged you upon arrival 4	Greeted, welcomed and acknowledged you upon arrival 5	Greeted, welcomed and acknowledged you upon arrival NA
Was knowledgeable about hyperbaric oxygen treatment	Was knowledgeable about hyperbaric oxygen treatment 1	Was knowledgeable about hyperbaric oxygen treatment 2	Was knowledgeable about hyperbaric oxygen treatment 3	Was knowledgeable about hyperbaric oxygen treatment 4	Was knowledgeable about hyperbaric oxygen treatment 5	Was knowledgeable about hyperbaric oxygen treatment NA
Skillful in administering treatment	Skillful in administering treatment 1	Skillful in administering treatment 2	Skillful in administering treatment 3	Skillful in administering treatment 4	Skillful in administering treatment 5	Skillful in administering treatment NA
Explained treatment procedure regarding clothing, accessories, etc.	Explained treatment procedure regarding clothing, accessories, etc. 1	Explained treatment procedure regarding clothing, accessories, etc. 2	Explained treatment procedure regarding clothing, accessories, etc. 3	Explained treatment procedure regarding clothing, accessories, etc. 4	Explained treatment procedure regarding clothing, accessories, etc. 5	Explained treatment procedure regarding clothing, accessories, etc. NA
Obtained comfortable scrubs and assisted when necessary	Obtained comfortable scrubs and assisted when necessary 1	Obtained comfortable scrubs and assisted when necessary 2	Obtained comfortable scrubs and assisted when necessary 3	Obtained comfortable scrubs and assisted when necessary 4	Obtained comfortable scrubs and assisted when necessary 5	Obtained comfortable scrubs and assisted when necessary NA

Other (please specify)

4. Treatment Phase

	1	2	3	4	5	NA
Felt treatment was successful	*Treatment Phase Felt treatment was successful 1	Felt treatment was successful 2	Felt treatment was successful 3	Felt treatment was successful 4	Felt treatment was successful 5	Felt treatment was successful NA
Would return if further treatment is needed	Would return if further treatment is needed 1	Would return if further treatment is needed 2	Would return if further treatment is needed 3	Would return if further treatment is needed 4	Would return if further treatment is needed 5	Would return if further treatment is needed NA
Would refer our Hyperbaric clinic to friends and family	Would refer our Hyperbaric clinic to friends and family 1	Would refer our Hyperbaric clinic to friends and family 2	Would refer our Hyperbaric clinic to friends and family 3	Would refer our Hyperbaric clinic to friends and family 4	Would refer our Hyperbaric clinic to friends and family 5	Would refer our Hyperbaric clinic to friends and family NA

Other (please specify)

5. Other

	Yes	No	NA
Stayed for full number of treatments suggested	*Other Stayed for full number of treatments suggested Yes	Stayed for full number of treatments suggested No	Stayed for full number of treatments suggested NA
Have already referrred our Hyperbaric clinic to friends or family	Have already referrred our Hyperbaric clinic to friends or family Yes	Have already referrred our Hyperbaric clinic to friends or family No	Have already referrred our Hyperbaric clinic to friends or family NA

Other (please specify)

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