Patient Access & Communication Survey
Thank you for taking the time to share your experience with us.
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1.
Select your appointment type:
(Required.)
Telehealth Phone
Telehealth Video
Visit to the Orange Office (4310 Orange St., Riverside, CA 92501)
Visit to the Riverwalk Office (4244 Riverwalk Pkwy #150, Riverside, CA 92505)
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2.
How soon were you able to receive an appointment:
(Required.)
Same day
Within 1-2 days
Within 3-4 days
More than 5 days
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3.
Did we have a time or appointment that worked well for you?
(Required.)
Yes
No
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4.
The clinician you saw for your visit:
(Required.)
Dr. Tarek Mahdi
Dr. Farah Almudhafar
Dr. Vicky Mai
Dr. Maryam Soltani
Dr. Benjamin Mahdi
Dr. Ana Ivanova
Cielito Capistrano, F-NP
Megg Sofeso, F-NP
Dr. Kacie Paik
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5.
Did you receive an appointment with your clinician of choice?
(Required.)
Yes
No
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6.
If you had an office visit, how much time do you estimate you spent in our office:
(Required.)
20 - 45 minutes
45 - 60 minutes
Over an hour
I had a telehealth appointment
Please rate the following:
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7.
The courtesy of the person who scheduled your appointment
(Required.)
Poor
Fair
Good
Very Good
Excellent
N/A
Poor
Fair
Good
Very Good
Excellent
N/A
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8.
The friendliness of the receptionist
(Required.)
Poor
Fair
Good
Very Good
Excellent
N/A
Poor
Fair
Good
Very Good
Excellent
N/A
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9.
The caring concern of our nurses/medical assistants
(Required.)
Poor
Fair
Good
Very Good
Excellent
N/A
Poor
Fair
Good
Very Good
Excellent
N/A
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10.
The provider listened carefully to my concerns
(Required.)
Poor
Fair
Good
Very Good
Excellent
Poor
Fair
Good
Very Good
Excellent
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11.
The instructions given to me for follow-up care were easy to understand
(Required.)
Poor
Fair
Good
Very Good
Excellent
Poor
Fair
Good
Very Good
Excellent
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12.
Overall experience with our office
(Required.)
Poor
Fair
Good
Very Good
Excellent
Poor
Fair
Good
Very Good
Excellent
Please answer the following questions:
*
13.
Did someone from this provider’s office talk with you about your specific health goals and steps to achieve them?
(Required.)
Yes
No
N/A
*
14.
If you are a current smoker, were you provided with resources and/or counseling on how to quit?
(Required.)
Yes
No
I am not a smoker
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15.
During your visit, did your care team provide enough information on any new or existing referrals and/or orders? (Labs, specialist referrals, x-ray, etc.)?
(Required.)
Yes
No
N/A
*
16.
Would you recommend the provider to others?
(Required.)
Yes
No
17.
If no, please tell us why:
18.
Is there anything we could have done to improve your visit?
19.
Is there anyone that stood out, or went above and beyond in providing excellent care for you?
