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Post Visit Patient Satisfaction Survey
1.
How likely are you to recommend your provider to family and friends ?
Not Likely
Somewhat Likely
Likely
Very Likely
Definately
*
2.
How easy or difficult was it to schedule your appointment for today?
(Required.)
Very Difficult
Difficult
Neither easy nor difficult
Easy
Very Easy
*
3.
How convenient was the appointment time you were able to get?
(Required.)
Not Convenient
Somewhat Convenient
Convenient
Very Convenient
Extremely Convenient
*
4.
How well do feel your provider listened to your needs?
(Required.)
Not well
Somewhat well
Well
Very Well
Extremely Well
*
5.
How well did your provider explain your follow-up care?
(Required.)
Not Well
Somewhat Well
Well
Very Well
Extremely Well
6.
Is there anything we could have done to improve your last visit?