Survey for Dr. Wendy Winckelbach and Southside Foot Clinic

* 1. What is your full name? (optional)

* 2. Our records show that you got care from Dr. Wendy Winckelbach. Is that right?

* 3. How long have you been going to Dr. Winckelbach?

* 4. In the last 12 months, how many times did you visit Dr. Winckelbach?

* 5. In the last 12 months, when you phoned Dr. Winckelbach’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?

* 6. How convenient was the appointment time you were able to get?

* 7. Typically, how long do you wait when you come in for an appointment at Dr. Winckelbach?

* 8. How long has it been since your most recent visit with Dr. Winckelbach?

* 9. During your most recent visit, did Dr. Winckelbach explain things in a way that was easy to understand?

* 10. During your most recent visit, did Dr. Winckelbach listen carefully to you?

* 11. During your most recent visit, did Dr. Winckelbach give you easy to understand information about these health questions or concerns?

* 12. During your most recent visit, did Dr. Winckelbach seem to know the important information about your medical history?

* 13. During your most recent visit, did Dr. Winckelbach show respect for what you had to say?

* 14. During your most recent visit, did Dr. Winckelbach spend enough time with you?

* 15. During your most recent visit, did Dr. Winckelbach order a blood test, x-ray, or other test for you?

* 16. Did Dr. Winckelbach go over those results with you in the office?

* 17. Did you recieve a phone call from the office about your results?

* 18. How likely is it that you would recommend Dr. Winckelbach to a friend or family member?

Not at all likely
Extremely likely

* 19. During your most recent visit, was check-in at as helpful as you thought they should be?

* 20. During your most recent visit, did check-in at treat you with courtesy and respect?

* 21. How professional do you think the check-in staff was?

* 22. How friendly was the check-in office staff?

* 23. During your visit, who was your medical assistant?

* 24. During your most recent visit, was your medical assistant as helpful as you thought they should be?

* 25. Did your medical assistant treat you with courtesy and respect?

* 26. Was your medical assistant knowledgeable about you and your health concerns. 

* 27. How professional do you think the medical assistant staff was?

* 28. How friendly was the medical assistant?

* 29. During your most recent visit, was check-out as helpful as you thought they should be?

* 30. During your most recent visit, did check-out treat you with courtesy and respect?

* 31. How professional do you think the check-out staff was?

* 32. How friendly was the check-out office staff?

* 33. Did you have interaction with the office manager?

* 34. Was the office manager as helpful as you thought they should be?

* 35. Did the office manager treat you with courtesy and respect?

* 36. How professional do you think the office manager was?

* 37. How friendly was the office manager?

* 38. Have you had an interaction with the billing service?

* 39. Whom did you speak with?

* 40. Did the billing service treat you with courtesy and respect?

* 41. Was the billing service as helpful as you thought they should be?

* 42. How professional do you think the billing service was?

* 43. How friendly was the billing service?

* 44. Overall, how would you rate the service you received from the staff at Southside Foot Clinic?

* 45. Overall, how would you rate the care you received from Dr. Winckelbach?

* 46. How comfortable was the lobby and waiting area?

* 47. Are you male or female?

* 48. What is your age?

* 49. What is the highest grade or level of school that you have completed?

* 50. What is your race? Mark one or more.

* 51. Is there anything we could have done to improve your last visit?

* 52. Please provide any feedback about Dr. Winckelbach.

* 53. Please provide any feedback about the office manager and/or your medical assistant.

* 54. Please provide any feedback or improvements you would like to see regarding our office space.

* 55. Please provide any feedback about the front office check-in.

* 56. Please provide any feedback about the front office check-out.

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