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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