PATIENT SATISFACTION SURVEY


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* 1. Patient Information:

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* 2. Who is your PRIMARY provider?

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* 3. Did you see the provider of your choice during your visit?

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* 4. Patient Satisfaction:

  Strongly Disagree Disagree Agree Strongly Agree
Your appointment was scheduled in a reasonable time frame.
The office hours were convenient.
The facility was clean.
Office staff was courteous and helpful.
Wait time was reasonable.
I had adequate time with my provider.
I feel comfortable with my treatment plan.
I received adequate instructions or information on my condition.
I feel confident in my knowledge and ability to provide self care (ie. diet, exercise, taking medications prescribed, glucose testing (if applicable) etc.) for my condition.
I feel comfortable communicating with my doctors office to report changes in my symptoms.

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* 5. Patient Communication

  Never Sometimes Often Frequently Always N/A
I got an answer to my medical question within 24 hours.
I got an answer to my medical question after normal business hours.
I received courteous and respectful answers from practice staff and care team.
I got an appointment for urgent care in a timely manner.
I got an appointment for non-urgent care in a timely manner.

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* 6. While in our office, how often did your nurse:

  Never Sometimes Often Frequently Always
Treat you with courtesy and respect?
Listen carefully to you?
Explain things in a way you could understand?
Take time to answer your questions?

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* 7. While in our office, how often did the doctor/provider:

  Never Sometimes Often Frequently Always
Treat you with courtesy and respect?
Listen carefully to you?
Explain things in a way you could understand?
Take time to answer your questions?

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* 8. Please rate the following:

  Not Involved/Satisfied Indifferent Extremely Involved/Satisfied
How involved are you in the management of your condition?
Overall, how would you rate your last visit?

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* 9. Have we made any changes that have enhanced your experience with our practice?

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* 10. What would make your experience at Dillon Internal Medicine better?

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* 11. Would you recommend this office to your family and friends?

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