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Satisfaction Survey
1.
Please select the location of your most recent visit with Horizon Family Medical Group:
Allergy & Immunology
Chester
Cornwall-Quaker
Cornwall-Rte 9W
Dermatology
Endo Suite-Middletown
Endo Suite-New Windsor
Florida
Goshen
Goshen GI-30 Hatfield
Goshen GI-70 Hatfield
Highland Falls
Maybrook
Monroe
Nephrology Goshen
New Windsor FP-Oakwood
New Windsor FP-Litte Britain
New WIndsor FP-Rte 9W
New Windsor- 270 Quassaick
New Windsor GI
New Windsor Nutrition
Opthalmology-Cornwall
Opthalmology-Goshen
Opthalmology-Newburgh
Pulmonology
Slate Hill
Warwick-Grand St
Warwick-Maple Ave
Washintonville
Weekends
Women's Health-Goshen
Women's Health-Highland Falls
List Name of provider you saw:
2.
When you made your most recent appointment with Horizon Family Medical Group, were you able to meet your date and time preferences?
Yes
No
3.
What is your age?
Less than 65
Greater than or equal to 65
4.
Were your expectations met during your last visit?
Yes
No
5.
Do our current weekend hours (Saturday 9:00 AM – 3:00 PM | Sunday 9:00 AM – 1:00 PM) meet your scheduling needs?
Yes
No
If no, what would you suggest:
6.
How satisfied were you with the courtness/friendliness of our nurses during your visit?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
7.
How satisfied were you with the time you waited before you were seen by your provider?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
8.
How satisfied were you with the courtness/friendliness of your provider during your visit?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
9.
How well did your doctor listen to you during your visit?
Extremely well
Very well
Moderately well
Slighty well
Not at all well
10.
How well did your doctor explain how to take your medicine(s)?
Extremely well
Very well
Moderately well
Slightly well
Not at all well
11.
How satisfied were you with the self-care management tools give to you at your appointment?(ex. patient literature,referral information,classes)
Satisfied
Dissatisfied
Not applicable
12.
How satisfied overall are you with the level of care you received during your last visit?
Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
13.
Do you ever recommend Horizon Family Medical Group to family and friends?
Yes
No
14.
If you were referred to a specialist: Did your primary care provider explain to you why you were being referred to a specialist?
Yes
No
Somewhat
Not Applicable
15.
If you were referred to a specialist: Did the specialist have all your necessary health history information,such as lab or x-ray results and your medication list prior to your arrival?
Yes
No
Somewhat
Not Applicable
16.
If you were referred to a specialist: Did the specialist communicate his/her findings back to your primary care doctor?Basically, did you get a sense that the two doctors were communicating with each other?
Yes
No
Somewhat
Not Applicable
