Dr. Desio Patient Satisfaction Survey

Please help us to continue providing the best possible care for our patients by taking this short survey. Your responses are confidential and are greatly appreciated.

1. Your age

Your age

2. Your Sex:

Your Sex: Male

Female

3. How did you hear about Dr. Desio

How did you hear about Dr. Desio Was a former patient

Referred by my Primary Care Physician

Referred by family or friend

From internet search

From Worcester Living Magazine advertisement

Other (please specify)

4. Please check the location of the problem for which you were being seen for your most recent visit

Please check the location of the problem for which you were being seen for your most recent visit Neck	Shoulder	Elbow	Wrist	Hip	Knee	Ankle	Foot
Other (please specify)

5. Please rate each of the following about the physical location of our office:

	Excellent	Good	Fair	Poor	N/A
The convenience of the office location	Please rate each of the following about the physical location of our office: The convenience of the office location Excellent	Good	Fair	Poor	N/A
The accessibility of the office	The accessibility of the office Excellent	Good	Fair	Poor	N/A
The comfort of the reception area	The comfort of the reception area Excellent	Good	Fair	Poor	N/A
The attractiveness of the reception area	The attractiveness of the reception area Excellent	Good	Fair	Poor	N/A
The comfort of the examining room	The comfort of the examining room Excellent	Good	Fair	Poor	N/A
The cleanliness of the office, including reception area and examination room	The cleanliness of the office, including reception area and examination room Excellent	Good	Fair	Poor	N/A

6. Please rate each of the following regarding the care you received

	Excellent	Good	Fair	Poor	N/A
The promptness with which our phones are answered	Please rate each of the following regarding the care you received The promptness with which our phones are answered Excellent	Good	Fair	Poor	N/A
The courtesy of the reception staff	The courtesy of the reception staff Excellent	Good	Fair	Poor	N/A
The wait time for an appointment	The wait time for an appointment Excellent	Good	Fair	Poor	N/A
The courtesy of the nursing staff	The courtesy of the nursing staff Excellent	Good	Fair	Poor	N/A
The amount of time spent with your provider	The amount of time spent with your provider Excellent	Good	Fair	Poor	N/A
The quality of the care your received	The quality of the care your received Excellent	Good	Fair	Poor	N/A
Overall, how would you rate your experience with the office staff	Overall, how would you rate your experience with the office staff Excellent	Good	Fair	Poor	N/A

7. Overall, How would you rate the care provided by Dr. Desio

Overall, How would you rate the care provided by Dr. Desio Excellent	Very Good	Good	Fair	Poor
Other (please specify)

8. I would recommend Dr. Desio to my family or friends

I would recommend Dr. Desio to my family or friends Yes

9. Please respond to how you agree with the following statements about our website

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
The website was easy to navigate	Please respond to how you agree with the following statements about our website The website was easy to navigate Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I prefer to communicate with my doctor by email	I prefer to communicate with my doctor by email Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
The website was up to date with clinical information	The website was up to date with clinical information Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A
I like to see my doctor's credentials on their website	I like to see my doctor's credentials on their website Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	N/A

10. I prefer to fill our my forms for my appointment (check all that apply)

I prefer to fill our my forms for my appointment (check all that apply) When I get to the doctors office

At home after they are mailed to me

At home after they are emailed to me

Online and submit them electronically

Other (please specify)

11. Please use the space below to note any compliments or complaints you may have to make our office better.

Please use the space below to note any compliments or complaints you may have to make our office better.