* 1. Please rate our scheduling.

  Excellent Good Fair Poor
For a sick/problem visit: Able to get an appointment within a reasonable amount of time.
For a physical/well visit: Able to get an appointment within a reasonable amount of time.
The convenience of our hours and available appointment times.
The ability to see the provider of your choice.
The wait time to see your nurse was reasonable.
The wait time to see your provider was reasonable.

* 2. Please rate your wait time in office.

  5-15 Minutes 20-30 Minutes 35-45 Minutes Over 50 Minutes
Wait time to see nurse.
Wait time to see a provider.

* 3. Please rate facilities.

  Excellent Good Fair Poor
The cleanliness and comfort of the office itself.
Our parking facilities.
Availability of adult reading materials.
Availability of children's books or toys.

* 4. Please rate the courtesy, helpfulness, and knowledge of our staff.

  Excellent Good Fair Poor
Receptionist
Schedulers
Nurse
Billing

* 5. Please rate our communication and coordination of care.

  Excellent Good Fair Poor
Your ease in reaching our office by phone.
If your call required a return call from a nurse, the call was returned in a reasonable amount of time.
If your call required a return call from a provider, the call was returned in a reasonable amount of time
Quality of information of medical advice provided by phone.
Our timeliness in completing any forms, paperwork requests, or specialist referrals.
Keeping you informed of any delays with your appointment.
Timely notification of test, lab, and/or imaging results.

* 6. Pleas rate your visit with your provider.

  Excellent Good Fair Poor
Courtesy of the provider.
Provider's patience and interest in your reason for visit.
Explanations of diagnosis and treatment options.
Your overall satisfaction with the medical care you received.
Assistance and support for making changes in health habits and making health care decisions.

* 7. General Office Questions.

  Yes No
Have you used our website for patient services?
Have you used our after-hours call service?
Would your recommend this practice to a family member or friend?
Would you like to see after-hours and/or Saturday clinic hours?

* 8. How many years have your been a patient in our practice?

* 9. Please rate your overall satisfaction with our practice.

  Excellent Good Fair Poor
Please rate your overall satisfaction with our practice.

* 10. Please give any suggestions you may have for us to better our practice and your satisfaction.

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