Customer Satisfaction Survey

We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance. Your input will help us improve our services.
(ALL SUBMISSIONS ARE ANONYMOUS)

1. How easy was it for you to book an appointment?

How easy was it for you to book an appointment? Very easy

Easy

Difficult

Very Difficult

Please leave any comments below

2. Were you satisfied with the timing of your appointment?

Were you satisfied with the timing of your appointment? Very Satisfied - I didn't have to wait long for my appointment

Satisfied

Dissatisfied

Very Dissatisfied - I had to wait a long time for my appointment

Please leave any comments below

3. After you arrived in the office and signed in, how long did you have to wait before seeing a doctor/provider?

After you arrived in the office and signed in, how long did you have to wait before seeing a doctor/provider? 5 minutes

10 minutes

15 minutes

20 minutes

30 minutes

more than 45 minutes

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4. Ability to choose provider and check in at front desk

	Yes	No
Was the check in process at front desk quick and easy?	*Ability to choose provider and check in at front desk Was the check in process at front desk quick and easy? Yes	Was the check in process at front desk quick and easy? No
Were there any problems with insurance coverage that caused problems with today's visit	Were there any problems with insurance coverage that caused problems with today's visit Yes	Were there any problems with insurance coverage that caused problems with today's visit No
Were you able to see the provider / physician of your choice?	Were you able to see the provider / physician of your choice? Yes	Were you able to see the provider / physician of your choice? No

Please leave any comments below

5. Please rate your experiences with each of the following:

	Excellent	Good	Adequate	Poor	Unacceptable
When you called the clinic, the person who answered the phone was prompt.	*Please rate your experiences with each of the following: When you called the clinic, the person who answered the phone was prompt. Excellent	When you called the clinic, the person who answered the phone was prompt. Good	When you called the clinic, the person who answered the phone was prompt. Adequate	When you called the clinic, the person who answered the phone was prompt. Poor	When you called the clinic, the person who answered the phone was prompt. Unacceptable
Your check-in process was efficient.	Your check-in process was efficient. Excellent	Your check-in process was efficient. Good	Your check-in process was efficient. Adequate	Your check-in process was efficient. Poor	Your check-in process was efficient. Unacceptable
The clinician staff was friendly and polite	The clinician staff was friendly and polite Excellent	The clinician staff was friendly and polite Good	The clinician staff was friendly and polite Adequate	The clinician staff was friendly and polite Poor	The clinician staff was friendly and polite Unacceptable
All of your questions/concerns were answered by your Doctor/provider.	All of your questions/concerns were answered by your Doctor/provider. Excellent	All of your questions/concerns were answered by your Doctor/provider. Good	All of your questions/concerns were answered by your Doctor/provider. Adequate	All of your questions/concerns were answered by your Doctor/provider. Poor	All of your questions/concerns were answered by your Doctor/provider. Unacceptable
Office cleanliness	Office cleanliness Excellent	Office cleanliness Good	Office cleanliness Adequate	Office cleanliness Poor	Office cleanliness Unacceptable
Please rate your overall experience at the clinic today.	Please rate your overall experience at the clinic today. Excellent	Please rate your overall experience at the clinic today. Good	Please rate your overall experience at the clinic today. Adequate	Please rate your overall experience at the clinic today. Poor	Please rate your overall experience at the clinic today. Unacceptable

Please leave any comments below

Customer Satisfaction Survey
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How Are We Doing?

1. How easy was it for you to book an appointment?

2. Were you satisfied with the timing of your appointment?

3. After you arrived in the office and signed in, how long did you have to wait before seeing a doctor/provider?

4. Ability to choose provider and check in at front desk

5. Please rate your experiences with each of the following:

Customer Satisfaction SurveyCancel this survey >>

How Are We Doing?

1. How easy was it for you to book an appointment?

2. Were you satisfied with the timing of your appointment?

3. After you arrived in the office and signed in, how long did you have to wait before seeing a doctor/provider?

4. Ability to choose provider and check in at front desk

5. Please rate your experiences with each of the following:

Customer Satisfaction Survey
Cancel this survey >>