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PAMPA Patient Survey
1. PAMPA Patient Satisfaction Survey
The purpose of the survey is to allow our practice to improve the experience of parents and patients. Thank you in advance for providing your invaluable feedback.
1
. Which office did you visit?
Atlanta (Mt. Vernon)
Marietta
Roswell
Woodstock
Which office did you visit?
2
. What day did you visit our practice?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What day did you visit our practice?
3
. What time of day was your appointment?
Morning
Noon
Afternoon
What time of day was your appointment?
4
. Which provider did you see?
--- SELECT DOCTOR ---
Dr. Stephen King
Dr. Patricia Nevius
Dr. Andy Andrews
Dr. Donna Fearing
Dr. Stephanie Lynn Hassel
Dr. Bakari Morgan
Dr. Julia M. Worly
Dr. Neelima Turlapaty
Dr. Tamara Nix
Dr. Nicole Smail
Dr. Richard Bien
Dr. Dina Royal
--- SELECT NURSE PRACTITIONER ---
Christine Chernik, CPNP
Debbie King, CFNP
Karen Campbell, CPNP
Kelly Reed, CPNP
Libby Scheffer, CPNP
Which provider did you see?
5
. Please rate your experience with the following:
Strongly Agree
Agree
Disagree
Strongly Disagree
My care in the office was completed within an hour of my appointment time:
*
Please rate your experience with the following: My care in the office was completed within an hour of my appointment time: Strongly Agree
My care in the office was completed within an hour of my appointment time: Agree
My care in the office was completed within an hour of my appointment time: Disagree
My care in the office was completed within an hour of my appointment time: Strongly Disagree
I was satisfied with the care I received:
I was satisfied with the care I received: Strongly Agree
I was satisfied with the care I received: Agree
I was satisfied with the care I received: Disagree
I was satisfied with the care I received: Strongly Disagree
I had a positive experience with office staff:
I had a positive experience with office staff: Strongly Agree
I had a positive experience with office staff: Agree
I had a positive experience with office staff: Disagree
I had a positive experience with office staff: Strongly Disagree
Overall, I was satisfied with my visit:
Overall, I was satisfied with my visit: Strongly Agree
Overall, I was satisfied with my visit: Agree
Overall, I was satisfied with my visit: Disagree
Overall, I was satisfied with my visit: Strongly Disagree
Comments:
6
. Please provide any additional feedback that you feel would help our practice improve our service. If we did a great job, then please let us know that too!
Please provide any additional feedback that you feel would help our practice improve our service. If we did a great job, then please let us know that too!
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