COMC Patient Satisfaction Survey
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1. COMCLLC Patient Survey

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We want to be sure we are providing the best in patient service. Please complete this survey and let us know how we are doing. We appreciate your choosing us for your care.

1. YOUR APPOINTMENT

PLEASE RATE THE FOLLOWING:

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
Ease of making appointments by phone.	*YOUR APPOINTMENT PLEASE RATE THE FOLLOWING: Ease of making appointments by phone. Excellent(5)	Ease of making appointments by phone. Very Good(4)	Ease of making appointments by phone. Good(3)	Ease of making appointments by phone. Fair(2)	Ease of making appointments by phone. Poor(1)	Ease of making appointments by phone. N/A
Appointment available within a reasonable amount of time.	Appointment available within a reasonable amount of time. Excellent(5)	Appointment available within a reasonable amount of time. Very Good(4)	Appointment available within a reasonable amount of time. Good(3)	Appointment available within a reasonable amount of time. Fair(2)	Appointment available within a reasonable amount of time. Poor(1)	Appointment available within a reasonable amount of time. N/A
Getting care for illness/injury as soon as you wanted it.	Getting care for illness/injury as soon as you wanted it. Excellent(5)	Getting care for illness/injury as soon as you wanted it. Very Good(4)	Getting care for illness/injury as soon as you wanted it. Good(3)	Getting care for illness/injury as soon as you wanted it. Fair(2)	Getting care for illness/injury as soon as you wanted it. Poor(1)	Getting care for illness/injury as soon as you wanted it. N/A
Getting after-hours care when you needed it.	Getting after-hours care when you needed it. Excellent(5)	Getting after-hours care when you needed it. Very Good(4)	Getting after-hours care when you needed it. Good(3)	Getting after-hours care when you needed it. Fair(2)	Getting after-hours care when you needed it. Poor(1)	Getting after-hours care when you needed it. N/A
The efficiency of the check-in process.	The efficiency of the check-in process. Excellent(5)	The efficiency of the check-in process. Very Good(4)	The efficiency of the check-in process. Good(3)	The efficiency of the check-in process. Fair(2)	The efficiency of the check-in process. Poor(1)	The efficiency of the check-in process. N/A
Waiting time in the reception area.	Waiting time in the reception area. Excellent(5)	Waiting time in the reception area. Very Good(4)	Waiting time in the reception area. Good(3)	Waiting time in the reception area. Fair(2)	Waiting time in the reception area. Poor(1)	Waiting time in the reception area. N/A
Waiting time in the exam room.	Waiting time in the exam room. Excellent(5)	Waiting time in the exam room. Very Good(4)	Waiting time in the exam room. Good(3)	Waiting time in the exam room. Fair(2)	Waiting time in the exam room. Poor(1)	Waiting time in the exam room. N/A
Keeping you informed if your appointment time was delayed.	Keeping you informed if your appointment time was delayed. Excellent(5)	Keeping you informed if your appointment time was delayed. Very Good(4)	Keeping you informed if your appointment time was delayed. Good(3)	Keeping you informed if your appointment time was delayed. Fair(2)	Keeping you informed if your appointment time was delayed. Poor(1)	Keeping you informed if your appointment time was delayed. N/A
Ease of getting referral when you needed one.	Ease of getting referral when you needed one. Excellent(5)	Ease of getting referral when you needed one. Very Good(4)	Ease of getting referral when you needed one. Good(3)	Ease of getting referral when you needed one. Fair(2)	Ease of getting referral when you needed one. Poor(1)	Ease of getting referral when you needed one. N/A

2. OUR STAFF

PLEASE RATE THE FOLLOWING:

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
The courtesy of the person who took your call.	*OUR STAFF PLEASE RATE THE FOLLOWING: The courtesy of the person who took your call. Excellent(5)	The courtesy of the person who took your call. Very Good(4)	The courtesy of the person who took your call. Good(3)	The courtesy of the person who took your call. Fair(2)	The courtesy of the person who took your call. Poor(1)	The courtesy of the person who took your call. N/A
The friendliness and courtesy of the receptionist.	The friendliness and courtesy of the receptionist. Excellent(5)	The friendliness and courtesy of the receptionist. Very Good(4)	The friendliness and courtesy of the receptionist. Good(3)	The friendliness and courtesy of the receptionist. Fair(2)	The friendliness and courtesy of the receptionist. Poor(1)	The friendliness and courtesy of the receptionist. N/A
The caring concern of our nurses/medical assistants.	The caring concern of our nurses/medical assistants. Excellent(5)	The caring concern of our nurses/medical assistants. Very Good(4)	The caring concern of our nurses/medical assistants. Good(3)	The caring concern of our nurses/medical assistants. Fair(2)	The caring concern of our nurses/medical assistants. Poor(1)	The caring concern of our nurses/medical assistants. N/A
The helpfulness of the people who assisted you with billing.	The helpfulness of the people who assisted you with billing. Excellent(5)	The helpfulness of the people who assisted you with billing. Very Good(4)	The helpfulness of the people who assisted you with billing. Good(3)	The helpfulness of the people who assisted you with billing. Fair(2)	The helpfulness of the people who assisted you with billing. Poor(1)	The helpfulness of the people who assisted you with billing. N/A
The professionalism of our x-ray staff.	The professionalism of our x-ray staff. Excellent(5)	The professionalism of our x-ray staff. Very Good(4)	The professionalism of our x-ray staff. Good(3)	The professionalism of our x-ray staff. Fair(2)	The professionalism of our x-ray staff. Poor(1)	The professionalism of our x-ray staff. N/A

3. OUR COMMUNICATION WITH YOU

PLEASE RATE THE FOLLOWING

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
Your phone calls answered promptly.	*OUR COMMUNICATION WITH YOU PLEASE RATE THE FOLLOWING Your phone calls answered promptly. Excellent(5)	Your phone calls answered promptly. Very Good(4)	Your phone calls answered promptly. Good(3)	Your phone calls answered promptly. Fair(2)	Your phone calls answered promptly. Poor(1)	Your phone calls answered promptly. N/A
Getting advice or help when needed during office hours.	Getting advice or help when needed during office hours. Excellent(5)	Getting advice or help when needed during office hours. Very Good(4)	Getting advice or help when needed during office hours. Good(3)	Getting advice or help when needed during office hours. Fair(2)	Getting advice or help when needed during office hours. Poor(1)	Getting advice or help when needed during office hours. N/A
Explanation of your procedure.	Explanation of your procedure. Excellent(5)	Explanation of your procedure. Very Good(4)	Explanation of your procedure. Good(3)	Explanation of your procedure. Fair(2)	Explanation of your procedure. Poor(1)	Explanation of your procedure. N/A
Your test results reported in a reasonable amount of time.	Your test results reported in a reasonable amount of time. Excellent(5)	Your test results reported in a reasonable amount of time. Very Good(4)	Your test results reported in a reasonable amount of time. Good(3)	Your test results reported in a reasonable amount of time. Fair(2)	Your test results reported in a reasonable amount of time. Poor(1)	Your test results reported in a reasonable amount of time. N/A
Effectiveness of our health information materials.	Effectiveness of our health information materials. Excellent(5)	Effectiveness of our health information materials. Very Good(4)	Effectiveness of our health information materials. Good(3)	Effectiveness of our health information materials. Fair(2)	Effectiveness of our health information materials. Poor(1)	Effectiveness of our health information materials. N/A
Your ability to contact us after hours.	Your ability to contact us after hours. Excellent(5)	Your ability to contact us after hours. Very Good(4)	Your ability to contact us after hours. Good(3)	Your ability to contact us after hours. Fair(2)	Your ability to contact us after hours. Poor(1)	Your ability to contact us after hours. N/A
Your ability to obtain prescription refills by phone.	Your ability to obtain prescription refills by phone. Excellent(5)	Your ability to obtain prescription refills by phone. Very Good(4)	Your ability to obtain prescription refills by phone. Good(3)	Your ability to obtain prescription refills by phone. Fair(2)	Your ability to obtain prescription refills by phone. Poor(1)	Your ability to obtain prescription refills by phone. N/A

4. YOUR VISIT WITH THE PROVIDER
(Doctor, Physician Assistant,Nurse Practitioner)

PLEASE RATE THE FOLLOWING:

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
Willingness to listen carefully to you.	*YOUR VISIT WITH THE PROVIDER (Doctor, Physician Assistant,Nurse Practitioner) PLEASE RATE THE FOLLOWING: Willingness to listen carefully to you. Excellent(5)	Willingness to listen carefully to you. Very Good(4)	Willingness to listen carefully to you. Good(3)	Willingness to listen carefully to you. Fair(2)	Willingness to listen carefully to you. Poor(1)	Willingness to listen carefully to you. N/A
Taking time to answer your questions.	Taking time to answer your questions. Excellent(5)	Taking time to answer your questions. Very Good(4)	Taking time to answer your questions. Good(3)	Taking time to answer your questions. Fair(2)	Taking time to answer your questions. Poor(1)	Taking time to answer your questions. N/A
Amount of time spent with you.	Amount of time spent with you. Excellent(5)	Amount of time spent with you. Very Good(4)	Amount of time spent with you. Good(3)	Amount of time spent with you. Fair(2)	Amount of time spent with you. Poor(1)	Amount of time spent with you. N/A
Explaining things in a way you could understand.	Explaining things in a way you could understand. Excellent(5)	Explaining things in a way you could understand. Very Good(4)	Explaining things in a way you could understand. Good(3)	Explaining things in a way you could understand. Fair(2)	Explaining things in a way you could understand. Poor(1)	Explaining things in a way you could understand. N/A
Instructions regarding medication/follow-up care.	Instructions regarding medication/follow-up care. Excellent(5)	Instructions regarding medication/follow-up care. Very Good(4)	Instructions regarding medication/follow-up care. Good(3)	Instructions regarding medication/follow-up care. Fair(2)	Instructions regarding medication/follow-up care. Poor(1)	Instructions regarding medication/follow-up care. N/A
The thoroughness of the examination.	The thoroughness of the examination. Excellent(5)	The thoroughness of the examination. Very Good(4)	The thoroughness of the examination. Good(3)	The thoroughness of the examination. Fair(2)	The thoroughness of the examination. Poor(1)	The thoroughness of the examination. N/A
Advice given to you on ways to stay healthy.	Advice given to you on ways to stay healthy. Excellent(5)	Advice given to you on ways to stay healthy. Very Good(4)	Advice given to you on ways to stay healthy. Good(3)	Advice given to you on ways to stay healthy. Fair(2)	Advice given to you on ways to stay healthy. Poor(1)	Advice given to you on ways to stay healthy. N/A

5. OUR FACILITY

PLEASE RATE TEH FOLLOWING:

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
Hours of operation convenient for you.	*OUR FACILITY PLEASE RATE TEH FOLLOWING: Hours of operation convenient for you. Excellent(5)	Hours of operation convenient for you. Very Good(4)	Hours of operation convenient for you. Good(3)	Hours of operation convenient for you. Fair(2)	Hours of operation convenient for you. Poor(1)	Hours of operation convenient for you. N/A
Overall comfort.	Overall comfort. Excellent(5)	Overall comfort. Very Good(4)	Overall comfort. Good(3)	Overall comfort. Fair(2)	Overall comfort. Poor(1)	Overall comfort. N/A
Adequate parking.	Adequate parking. Excellent(5)	Adequate parking. Very Good(4)	Adequate parking. Good(3)	Adequate parking. Fair(2)	Adequate parking. Poor(1)	Adequate parking. N/A
Signage and directions easy to follow.	Signage and directions easy to follow. Excellent(5)	Signage and directions easy to follow. Very Good(4)	Signage and directions easy to follow. Good(3)	Signage and directions easy to follow. Fair(2)	Signage and directions easy to follow. Poor(1)	Signage and directions easy to follow. N/A

6. YOUR OVERALL SATISFACTION

PLEASE RATE THE FOLLOWING:

	Excellent(5)	Very Good(4)	Good(3)	Fair(2)	Poor(1)	N/A
Our practice.	*YOUR OVERALL SATISFACTION PLEASE RATE THE FOLLOWING: Our practice. Excellent(5)	Our practice. Very Good(4)	Our practice. Good(3)	Our practice. Fair(2)	Our practice. Poor(1)	Our practice. N/A
The quality of your medical care.	The quality of your medical care. Excellent(5)	The quality of your medical care. Very Good(4)	The quality of your medical care. Good(3)	The quality of your medical care. Fair(2)	The quality of your medical care. Poor(1)	The quality of your medical care. N/A
Overall rating of care from your provider.	Overall rating of care from your provider. Excellent(5)	Overall rating of care from your provider. Very Good(4)	Overall rating of care from your provider. Good(3)	Overall rating of care from your provider. Fair(2)	Overall rating of care from your provider. Poor(1)	Overall rating of care from your provider. N/A

7. Would you recommend the provider to others? Why or why not?

Would you recommend the provider to others? Why or why not?

8. If there is any way we can improve our services to you, please tell us about it.

If there is any way we can improve our services to you, please tell us about it.

9. Are you:

Are you: A new patient

A returning patient

10. Your Age:

Your Age: Under 18

18-30

31-40

41-50

51-60

Over 60

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COMC Patient Satisfaction SurveyExit this survey

1. COMCLLC Patient Survey

1. YOUR APPOINTMENTPLEASE RATE THE FOLLOWING:

2. OUR STAFFPLEASE RATE THE FOLLOWING:

3. OUR COMMUNICATION WITH YOUPLEASE RATE THE FOLLOWING

4. YOUR VISIT WITH THE PROVIDER(Doctor, Physician Assistant,Nurse Practitioner)PLEASE RATE THE FOLLOWING:

5. OUR FACILITYPLEASE RATE TEH FOLLOWING:

6. YOUR OVERALL SATISFACTIONPLEASE RATE THE FOLLOWING: