Please rate your experience with the following aspects of your visit:

Question Title

* 1. Your waiting time in our reception area:

Question Title

* 2. Your waiting time in an exam room before your provider saw you:

Question Title

* 3. Ease of scheduling your appointment:

Question Title

* 4. The courtesy of the person who took your call:

Question Title

* 5. The courtesy of the Call Nurse (if you spoke with one):

Question Title

* 6. The friendliness and courtesy of the receptionist:

Question Title

* 7. Being kept informed if your appointment time was delayed:

Question Title

* 8. The caring concern of our nursing staff:

Question Title

* 9. The professionalism of our Ultrasound technicians (if you saw one):

Question Title

* 10. The courtesy and warmth of your care provider:

Question Title

* 11. Your provider's willingness to listen carefully to you and answer your questions:

Question Title

* 12. Your confidence in your care provider:

Question Title

* 13. The quality of the care you received from your provider:

Question Title

* 14. Would you recommend your care provider to others?

Question Title

* 15. Your overall satisfaction with our practice:

Question Title

* 16. We are considering expanding our office hours, in order to provider more convenient appointment times for our patients.  Please check off the days/times that you would prefer.

  Monday Tuesday Wednesday Thursday Friday Saturday 
7 am - 9 am
9 am - 12 pm
12 pm - 1 pm
1 pm - 5 pm
5 pm - 8 pm

Question Title

* 17. What can we do to improve your experience with our practice?

Share

T