patient satisfaction Survey

1. Was our staff member courteous when you called our office?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Telephone Courtesy	*Was our staff member courteous when you called our office? Telephone Courtesy Very Satisfied	Telephone Courtesy Satisfied	Telephone Courtesy Acceptable	Telephone Courtesy Dissatisfied	Telephone Courtesy Very Dissatisfied

2. Were you able to make an appointment that suited you?

	Within a Day of my Desired Date	Plus or minus a Day	During the week I Desired	A week later than I required	Unable to find a time within 2 weeks
Appointment Availability	*Were you able to make an appointment that suited you? Appointment Availability Within a Day of my Desired Date	Appointment Availability Plus or minus a Day	Appointment Availability During the week I Desired	Appointment Availability A week later than I required	Appointment Availability Unable to find a time within 2 weeks

3. Were the receptionists courteous, knowledgeable and professional when you came to our office?

	Very Satisfied	Satisfied	Acceptable	Not Satisfied	Dissatisfied
Office Courtesy	*Were the receptionists courteous, knowledgeable and professional when you came to our office? Office Courtesy Very Satisfied	Office Courtesy Satisfied	Office Courtesy Acceptable	Office Courtesy Not Satisfied	Office Courtesy Dissatisfied

4. Was the Waiting Room comfortable?

	Very Comfortable	Comfortable	Acceptable	Not Comfortable	Very Uncomfortable
Waiting Rooms	*Was the Waiting Room comfortable? Waiting Rooms Very Comfortable	Waiting Rooms Comfortable	Waiting Rooms Acceptable	Waiting Rooms Not Comfortable	Waiting Rooms Very Uncomfortable

5. Were the Medical Assistants courteous, knowledgeable and professional?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Medical Assistant Courtesy	*Were the Medical Assistants courteous, knowledgeable and professional? Medical Assistant Courtesy Very Satisfied	Medical Assistant Courtesy Satisfied	Medical Assistant Courtesy Acceptable	Medical Assistant Courtesy Dissatisfied	Medical Assistant Courtesy Very Dissatisfied

6. Did your provider see you in a timely manner?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Time waiting for your Provider	*Did your provider see you in a timely manner? Time waiting for your Provider Very Satisfied	Time waiting for your Provider Satisfied	Time waiting for your Provider Acceptable	Time waiting for your Provider Dissatisfied	Time waiting for your Provider Very Dissatisfied

7. Do you feel that your Provider listened to your needs?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Listened to	*Do you feel that your Provider listened to your needs? Listened to Very Satisfied	Listened to Satisfied	Listened to Acceptable	Listened to Dissatisfied	Listened to Very Dissatisfied

8. Do you feel that you Provider explained your treatment plan to you?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Explained Well	*Do you feel that you Provider explained your treatment plan to you? Explained Well Very Satisfied	Explained Well Satisfied	Explained Well Acceptable	Explained Well Dissatisfied	Explained Well Very Dissatisfied

9. Were your test results communicated to you in a timely manner?

	Very Satisfied	Satisfied	Acceptable	Dissatisfied	Very Dissatisfied
Timeliness of Test Results	*Were your test results communicated to you in a timely manner? Timeliness of Test Results Very Satisfied	Timeliness of Test Results Satisfied	Timeliness of Test Results Acceptable	Timeliness of Test Results Dissatisfied	Timeliness of Test Results Very Dissatisfied

10. What department(s) did you interact with?

	Yes
Administration/Management	*What department(s) did you interact with? Administration/Management Yes
Billing	Billing Yes
Medical Assistant(s)	Medical Assistant(s) Yes
Front Office/ Check-in or Check-out Staff	Front Office/ Check-in or Check-out Staff Yes
Medical Records	Medical Records Yes

Please feel free to tell us how we can better serve you:

patient satisfaction
Exit this survey