Wake Endoscopy Center – Patient Satisfaction Survey

While we strive to do our best, we want to know how you view our practice.
This survey is confidential and personal identification is not required.

Appointment with:

Appointment with: Dr. R Schwarz

Dr Gumber

Dr. C Schwarz

Dr. Battaglino

Dr Sachdeva

Dr Indira Reddy

Appointment Date:

	MM		DD		YYYY
Please enter your appointment date:	Appointment Date: Please enter your appointment date: Month	/	Day	/	Year

Patient Status:

Patient Status: I am a new patient

I am an established patient

Our Facility:

	agree	disagree	N/A
The office is conveniently located	*Our Facility: The office is conveniently located agree	The office is conveniently located disagree	The office is conveniently located N/A
Reception area is neat and welcoming.	Reception area is neat and welcoming. agree	Reception area is neat and welcoming. disagree	Reception area is neat and welcoming. N/A
Procedure room atmosphere is neat and clean	Procedure room atmosphere is neat and clean agree	Procedure room atmosphere is neat and clean disagree	Procedure room atmosphere is neat and clean N/A

Other (please specify)

Appointment/Phones:

	agree	disagree	N/A
Staff is courteous and helpful when scheduling an appointment.	*Appointment/Phones: Staff is courteous and helpful when scheduling an appointment. agree	Staff is courteous and helpful when scheduling an appointment. disagree	Staff is courteous and helpful when scheduling an appointment. N/A
I am able to obtain an appointment in a reasonable amount of time.	I am able to obtain an appointment in a reasonable amount of time. agree	I am able to obtain an appointment in a reasonable amount of time. disagree	I am able to obtain an appointment in a reasonable amount of time. N/A
The phone choices (auto-attendant) are easy to understand and easy to use	The phone choices (auto-attendant) are easy to understand and easy to use agree	The phone choices (auto-attendant) are easy to understand and easy to use disagree	The phone choices (auto-attendant) are easy to understand and easy to use N/A
I am able to speak to a scheduler or nurse when calling the office or I receive a call back in a timely manner.	I am able to speak to a scheduler or nurse when calling the office or I receive a call back in a timely manner. agree	I am able to speak to a scheduler or nurse when calling the office or I receive a call back in a timely manner. disagree	I am able to speak to a scheduler or nurse when calling the office or I receive a call back in a timely manner. N/A
Appointment time meets my needs.	Appointment time meets my needs. agree	Appointment time meets my needs. disagree	Appointment time meets my needs. N/A

Other (please specify)

Billing/Insurance Department:

	agree	disagree	N/A
My bill is easy to understand	*Billing/Insurance Department: My bill is easy to understand agree	My bill is easy to understand disagree	My bill is easy to understand N/A
Staff is courteous and friendly on the phone.	Staff is courteous and friendly on the phone. agree	Staff is courteous and friendly on the phone. disagree	Staff is courteous and friendly on the phone. N/A
Staff returns calls within a reasonable time frame	Staff returns calls within a reasonable time frame agree	Staff returns calls within a reasonable time frame disagree	Staff returns calls within a reasonable time frame N/A
Staff is competent in answering my insurance/billing issues or questions in a competent manner and language I can understand.	Staff is competent in answering my insurance/billing issues or questions in a competent manner and language I can understand. agree	Staff is competent in answering my insurance/billing issues or questions in a competent manner and language I can understand. disagree	Staff is competent in answering my insurance/billing issues or questions in a competent manner and language I can understand. N/A

Front Office Staff:

	agree	disagree	N/A
Front office staff greets me in a friendly manner and registers me promptly.	*Front Office Staff: Front office staff greets me in a friendly manner and registers me promptly. agree	Front office staff greets me in a friendly manner and registers me promptly. disagree	Front office staff greets me in a friendly manner and registers me promptly. N/A
Front office staff treats me with respect and courtesy.	Front office staff treats me with respect and courtesy. agree	Front office staff treats me with respect and courtesy. disagree	Front office staff treats me with respect and courtesy. N/A
Front office staff works with a professional and caring attitude.	Front office staff works with a professional and caring attitude. agree	Front office staff works with a professional and caring attitude. disagree	Front office staff works with a professional and caring attitude. N/A
The waiting time to register is acceptable.	The waiting time to register is acceptable. agree	The waiting time to register is acceptable. disagree	The waiting time to register is acceptable. N/A

Other (please specify)

Clinical Staff: Physician's Nurses

	agree	disagree	N/A
The nurses and staff greet me either personally or on the phone in a friendly and caring manner.	*Clinical Staff: Physician's Nurses The nurses and staff greet me either personally or on the phone in a friendly and caring manner. agree	The nurses and staff greet me either personally or on the phone in a friendly and caring manner. disagree	The nurses and staff greet me either personally or on the phone in a friendly and caring manner. N/A
My questions and needs are handled in an acceptable manner.	My questions and needs are handled in an acceptable manner. agree	My questions and needs are handled in an acceptable manner. disagree	My questions and needs are handled in an acceptable manner. N/A
Clinical Staff provides me with Educational materials that are helpful.	Clinical Staff provides me with Educational materials that are helpful. agree	Clinical Staff provides me with Educational materials that are helpful. disagree	Clinical Staff provides me with Educational materials that are helpful. N/A

Other (please specify)

Endoscopy Staff (Nurses and Technicians)

	agree	disagree	N/A
The Endoscopy Staff greets me in a friendly and caring manner.	*Endoscopy Staff (Nurses and Technicians) The Endoscopy Staff greets me in a friendly and caring manner. agree	The Endoscopy Staff greets me in a friendly and caring manner. disagree	The Endoscopy Staff greets me in a friendly and caring manner. N/A
The Endoscopy Staff is knowledgeble about the procedures and the post-procedural process and are able to communicate this information to patients and family members.	The Endoscopy Staff is knowledgeble about the procedures and the post-procedural process and are able to communicate this information to patients and family members. agree	The Endoscopy Staff is knowledgeble about the procedures and the post-procedural process and are able to communicate this information to patients and family members. disagree	The Endoscopy Staff is knowledgeble about the procedures and the post-procedural process and are able to communicate this information to patients and family members. N/A
The Wake Endoscopy staff made my experience as comfortable and stress free as possible.	The Wake Endoscopy staff made my experience as comfortable and stress free as possible. agree	The Wake Endoscopy staff made my experience as comfortable and stress free as possible. disagree	The Wake Endoscopy staff made my experience as comfortable and stress free as possible. N/A
I received my test results the day of the procedure and a copy of the report was given to me.	I received my test results the day of the procedure and a copy of the report was given to me. agree	I received my test results the day of the procedure and a copy of the report was given to me. disagree	I received my test results the day of the procedure and a copy of the report was given to me. N/A
Educational materials were made available to me by the staff.	Educational materials were made available to me by the staff. agree	Educational materials were made available to me by the staff. disagree	Educational materials were made available to me by the staff. N/A

Physician/Physician's Assistant:

	agree	disagree	N/A
My physician explained fully what he/she would be doing.	*Physician/Physician's Assistant: My physician explained fully what he/she would be doing. agree	My physician explained fully what he/she would be doing. disagree	My physician explained fully what he/she would be doing. N/A
Physician asked questions to understand my condition	Physician asked questions to understand my condition agree	Physician asked questions to understand my condition disagree	Physician asked questions to understand my condition N/A
My procedure was performed with minimal discomfort.	My procedure was performed with minimal discomfort. agree	My procedure was performed with minimal discomfort. disagree	My procedure was performed with minimal discomfort. N/A
I was notified of the pathology/lab/x-ray results in a timely manner.	I was notified of the pathology/lab/x-ray results in a timely manner. agree	I was notified of the pathology/lab/x-ray results in a timely manner. disagree	I was notified of the pathology/lab/x-ray results in a timely manner. N/A
The physician/physician's assistant demonstrates a caring and approachable attitude.	The physician/physician's assistant demonstrates a caring and approachable attitude. agree	The physician/physician's assistant demonstrates a caring and approachable attitude. disagree	The physician/physician's assistant demonstrates a caring and approachable attitude. N/A

Overall Satisfaction:

	agree	disagree	N/A
My privacy and the privacy of other patients is respected.	*Overall Satisfaction: My privacy and the privacy of other patients is respected. agree	My privacy and the privacy of other patients is respected. disagree	My privacy and the privacy of other patients is respected. N/A
I am satisfied with the medical/clinical services provided by Wake Endoscopy Center.	I am satisfied with the medical/clinical services provided by Wake Endoscopy Center. agree	I am satisfied with the medical/clinical services provided by Wake Endoscopy Center. disagree	I am satisfied with the medical/clinical services provided by Wake Endoscopy Center. N/A
I would recommend Wake Endoscopy Center to my family and friends.	I would recommend Wake Endoscopy Center to my family and friends. agree	I would recommend Wake Endoscopy Center to my family and friends. disagree	I would recommend Wake Endoscopy Center to my family and friends. N/A

Wake Endoscopy Center – Patient Satisfaction Survey

Your opinion matters to us!

Appointment with:

Appointment Date:

Patient Status:

Our Facility:

Appointment/Phones:

Billing/Insurance Department:

Front Office Staff:

Clinical Staff: Physician's Nurses

Endoscopy Staff (Nurses and Technicians)

Physician/Physician's Assistant:

Overall Satisfaction:

Your comments are welcomed. Thank you for taking your time to take the survey