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Patient satisfaction survey

1.What is your age?(Required.)
2.What is your gender?
3.How did you originally hear about us?(Required.)
4.When scheduling your appointment:
Yes
No
Were the staff friendly?
Was the process relatively easy?
Were your questions answered?
5.Which provider did you have an appointment with?
6.When you checked in for your appointment, was the front desk staff:
Yes
No
friendly and courteous?
competent and professional?
7.How many minutes after your scheduled appointment time were you seen by the provider?
8.During your appointment, did you find the provider to be:
Yes
No
friendly and courteous?
competent and professional?
sympathetic and caring?
9.How likely is it that you would recommend your provider to a friend or family?
10.Overall, how satisfied were you with the following:
Extremely satisfied
Satisfied
Unsatisfied
level of service from our billing staff
level of service from our scheduling staff
level of service from our front desk staff
level of service from our clinical support staff
level of service from our provider
condition of our lobby/waiting area