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Patient Satisfaction Survey

Thank you for taking the time to complete this survey!

Which doctor handled your care?

Which doctor handled your care? Dr. Barresi

Dr. Getz

Dr. Giles

Dr. Henson

Dr. Prier

Dr. Verner

If you called our office, was our automated phone menu easy to use?

	Excellent	Good	Okay	Somewhat difficult	Very difficult	N/A
Rating	If you called our office, was our automated phone menu easy to use? Rating Excellent	Rating Good	Rating Okay	Rating Somewhat difficult	Rating Very difficult	Rating N/A

Comments?

How helpful and courteous was our staff?

	Excellent	Good	Okay	Disappointing	Very Disappointing	N/A
Rating	How helpful and courteous was our staff? Rating Excellent	Rating Good	Rating Okay	Rating Disappointing	Rating Very Disappointing	Rating N/A

Comments?

How close to your appointment time did you see the doctor?

	Immediately	10 to 15 min	20 to 30 min	35 to 45 min	over 45 min	N/A
Rating	How close to your appointment time did you see the doctor? Rating Immediately	Rating 10 to 15 min	Rating 20 to 30 min	Rating 35 to 45 min	Rating over 45 min	Rating N/A

Comments?

How responsive was the nurse to your questions and needs?

	Excellent	Good	Okay	Disappointed	Very Disappointed	N/A
Rating	How responsive was the nurse to your questions and needs? Rating Excellent	Rating Good	Rating Okay	Rating Disappointed	Rating Very Disappointed	Rating N/A

Comments?

How competent do you feel your nurse was?

	Excellent	Good	Okay	Disappointed	Very Disappointed	N/A
Rating	How competent do you feel your nurse was? Rating Excellent	Rating Good	Rating Okay	Rating Disappointed	Rating Very Disappointed	Rating N/A

Comments?

Do you feel the doctor fully understood your medical condition?

	Excellent	Good	Okay	Disappointed	Very Disappointed	N/A
Rating	Do you feel the doctor fully understood your medical condition? Rating Excellent	Rating Good	Rating Okay	Rating Disappointed	Rating Very Disappointed	Rating N/A

Comments?

How well was your surgery explained?

	Excellent	Good	Okay	Disappointed	Very Disappointed	N/A
Rating	How well was your surgery explained? Rating Excellent	Rating Good	Rating Okay	Rating Disappointed	Rating Very Disappointed	Rating N/A

Comments?

How do you feel about the outcome of your surgery?

	Very satisfied	Satisfied	Okay	Disappointed	Very Disappointed	N/A
Rating	How do you feel about the outcome of your surgery? Rating Very satisfied	Rating Satisfied	Rating Okay	Rating Disappointed	Rating Very Disappointed	Rating N/A

Comments?

Would you recommend this doctor to your friends and family?

	Absolutely	Maybe	No
Rating	Would you recommend this doctor to your friends and family? Rating Absolutely	Rating Maybe	Rating No

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