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1. Patient Satisfaction Survey

Please fill out the following patient satisfaction survey.

1. How did you hear about us?

3. Ease of getting care:

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Ability to get in and be seen
Convenience of center's location
Prompt return on calls

4. Waiting:

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results

5. Physician

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Listens to you
Explains what you want to know
Gives you good advice and treatment

6. Nurses and Medical Assistants

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Friendly and helpful to you
Answers your questions

7. All Others

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Friendly and helpful to you
Answers your questions

8. Facility

  5 - Excellent 4 - Good 3 - Average 2 - Below Average 1 - Not Acceptable
Neat and clean building
Ease of finding where to go
Comfort and Safety while waiting

9. The likelihood of referring your friends and relatives to us

10. What do you like best about our clinic?

11. What do you like least about our clinic?

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