Physician Satisfaction Survey

We are committed to monitoring our performance by getting your feedback. We are committed to the development of a first rate program which we can only do with your input. Please take a moment to let us know how we are doing.(All submissions are anonymous.)

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	N/A
Communicated clearly and effectively with me	Communicated clearly and effectively with me Strongly Agree	Communicated clearly and effectively with me Agree	Communicated clearly and effectively with me Neutral	Communicated clearly and effectively with me Disagree	Communicated clearly and effectively with me Strongly Disagree	Communicated clearly and effectively with me N/A
Communicated courtesously and professionally	Communicated courtesously and professionally Strongly Agree	Communicated courtesously and professionally Agree	Communicated courtesously and professionally Neutral	Communicated courtesously and professionally Disagree	Communicated courtesously and professionally Strongly Disagree	Communicated courtesously and professionally N/A
Worked as a partner in the plan of care for my patient	Worked as a partner in the plan of care for my patient Strongly Agree	Worked as a partner in the plan of care for my patient Agree	Worked as a partner in the plan of care for my patient Neutral	Worked as a partner in the plan of care for my patient Disagree	Worked as a partner in the plan of care for my patient Strongly Disagree	Worked as a partner in the plan of care for my patient N/A
Provided assistance that improved patient care	Provided assistance that improved patient care Strongly Agree	Provided assistance that improved patient care Agree	Provided assistance that improved patient care Neutral	Provided assistance that improved patient care Disagree	Provided assistance that improved patient care Strongly Disagree	Provided assistance that improved patient care N/A
Responded promptly to my concerns	Responded promptly to my concerns Strongly Agree	Responded promptly to my concerns Agree	Responded promptly to my concerns Neutral	Responded promptly to my concerns Disagree	Responded promptly to my concerns Strongly Disagree	Responded promptly to my concerns N/A
I was satisfied with the way the hospitalist interacted with my patient	I was satisfied with the way the hospitalist interacted with my patient Strongly Agree	I was satisfied with the way the hospitalist interacted with my patient Agree	I was satisfied with the way the hospitalist interacted with my patient Neutral	I was satisfied with the way the hospitalist interacted with my patient Disagree	I was satisfied with the way the hospitalist interacted with my patient Strongly Disagree	I was satisfied with the way the hospitalist interacted with my patient N/A
I was personally treated with respect by hospitalist	I was personally treated with respect by hospitalist Strongly Agree	I was personally treated with respect by hospitalist Agree	I was personally treated with respect by hospitalist Neutral	I was personally treated with respect by hospitalist Disagree	I was personally treated with respect by hospitalist Strongly Disagree	I was personally treated with respect by hospitalist N/A
Hospitalist services were of value to me	Hospitalist services were of value to me Strongly Agree	Hospitalist services were of value to me Agree	Hospitalist services were of value to me Neutral	Hospitalist services were of value to me Disagree	Hospitalist services were of value to me Strongly Disagree	Hospitalist services were of value to me N/A

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

N/A

Communicated clearly and effectively with me

Communicated clearly and effectively with me Strongly Agree

Communicated clearly and effectively with me Agree

Communicated clearly and effectively with me Neutral

Communicated clearly and effectively with me Disagree

Communicated clearly and effectively with me Strongly Disagree

Communicated clearly and effectively with me N/A

Communicated courtesously and professionally

Communicated courtesously and professionally Strongly Agree

Communicated courtesously and professionally Agree

Communicated courtesously and professionally Neutral

Communicated courtesously and professionally Disagree

Communicated courtesously and professionally Strongly Disagree

Communicated courtesously and professionally N/A

Worked as a partner in the plan of care for my patient

Worked as a partner in the plan of care for my patient Strongly Agree

Worked as a partner in the plan of care for my patient Agree

Worked as a partner in the plan of care for my patient Neutral

Worked as a partner in the plan of care for my patient Disagree

Worked as a partner in the plan of care for my patient Strongly Disagree

Worked as a partner in the plan of care for my patient N/A

Provided assistance that improved patient care

Provided assistance that improved patient care Strongly Agree

Provided assistance that improved patient care Agree

Provided assistance that improved patient care Neutral

Provided assistance that improved patient care Disagree

Provided assistance that improved patient care Strongly Disagree

Provided assistance that improved patient care N/A

Responded promptly to my concerns

Responded promptly to my concerns Strongly Agree

Responded promptly to my concerns Agree

Responded promptly to my concerns Neutral

Responded promptly to my concerns Disagree

Responded promptly to my concerns Strongly Disagree

Responded promptly to my concerns N/A

I was satisfied with the way the hospitalist interacted with my patient

I was satisfied with the way the hospitalist interacted with my patient Strongly Agree

I was satisfied with the way the hospitalist interacted with my patient Agree

I was satisfied with the way the hospitalist interacted with my patient Neutral

I was satisfied with the way the hospitalist interacted with my patient Disagree

I was satisfied with the way the hospitalist interacted with my patient Strongly Disagree

I was satisfied with the way the hospitalist interacted with my patient N/A

I was personally treated with respect by hospitalist

I was personally treated with respect by hospitalist Strongly Agree

I was personally treated with respect by hospitalist Agree

I was personally treated with respect by hospitalist Neutral

I was personally treated with respect by hospitalist Disagree

I was personally treated with respect by hospitalist Strongly Disagree

I was personally treated with respect by hospitalist N/A

Hospitalist services were of value to me

Hospitalist services were of value to me Strongly Agree

Hospitalist services were of value to me Agree

Hospitalist services were of value to me Neutral

Hospitalist services were of value to me Disagree

Hospitalist services were of value to me Strongly Disagree

Hospitalist services were of value to me N/A

Physician Satisfaction Survey

How Are We Doing?

Question Title

* 1. What date and time are your responses to this survey related to?

Question Title

* 2. Please rate your experience with the hospitalist during the date and time listed above.

Question Title

* 3. Overall, how do you rate the quality of the hospitalist services we provide?

Question Title

* 4. What level of confidence do you have in us to deliver hospitalist services that improve patient safety?

Question Title

* 5. What best describes the role of the hospitalist as you understand it?

Question Title

* 6. Do you have a compliment/suggestion/complaint or comment to share? If so please enter below.