Patient Survey

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Please take a few minutes a fill out this confidential patient opinion survey. Our ultimate goal is to provide excellent care in the best possible setting. Because we want you to be satisfied, we are interested in your views about the services we provide. Your suggestions can help us better meet your needs in the future. Thanks in advance for your help.

I. OUR PRACTICE

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* 1. Is our office location convenient for you?

Yes

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* 2. Are the parking facilities adequate?

Yes

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* 3. Do our office hours accommadate your needs?

Yes

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* 4. Is our waiting room comfortable?

Yes

If No, please explain and tell us which office

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* 5. Is the reading material in the waiting room up-to-date and interesting?

Yes

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* 6. Is the examining room comfortable?

Yes

If No, please explain

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* 7. How did you learn about our practice?

If referred by another physician please specify physician

II. APPOINTMENT HANDLING

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* 8. When you call our office, are the telephones answered promptly?

Yes

If no, please indicate which office you were not satisfied with.

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* 9. Is our answering service responsive to your needs?

Yes

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* 10. Have you been put on hold for long periods?

Yes

Please specify how long

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* 11. Do you receive prompt appointments?

Yes

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* 12. How long do you normally wait in the waiting room?

Please indicate which office you visited.

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* 13. How long do you normally wait in the examine room?

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* 14. If you were kept waiting, did a staff member explain the reason?

Yes