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Patient Satisfaction Survey
1.
How easy was it to schedule your appointment?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
2.
Were you able to get an appointment in a timely manner
Yes
No
3.
How would you rate the ease of checking in?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
4.
Was your appointment started on time?
Yes
No
5.
Were the front desk staff polite and helpful?
Exceeded expectations
Met expectations
Below expectations
if below expectations, what went happened...
6.
Did the nursing/support staff treat you with respect?
Yes
No
if no, what went wrong...
7.
How would you rate the professionalism of the staff?
Extremely professional
Very professional
Somewhat professional
Not so professional
Not at all professional
please elaborate if unsatisfied...
8.
Did the doctor listen carefully to your concerns?
Extremely interested
Very interested
Somewhat interested
Not so interested
Not at all interested
Please elaborate if uninterested...
9.
Did the doctor explain things clearly?
Yes
No
10.
Did you feel involved in your care decisions?
A great deal
A lot
A moderate amount
A little
None at all
11.
Did the doctor spend enough quality time with you?
Very high quality
High quality
Neither high nor low quality
Low quality
Very low quality
12.
Was the clinic clean and well-maintained?
Yes
No
13.
Did you feel comfortable and safe?
Yes
No
14.
Overall, how satisfied were you with your visit?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
15.
Would you recommend this practice to others?
Yes
No
If no, why...
16.
Do you plan to return to this practice?
Yes
No
17.
· What did you like most about your visit?
18.
· What could we improve?
19.
· Any other comments or concerns?
