Patient Satisfaction Survey

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* 1. YOUR APPOINTMENT

  Excellent Very Good Good Fair Poor N/A
Ease of making appointments by phone
Appointment available within a reasonable amount of time
Getting care for illness/injury as soon as you wanted it
Getting after-hours care when you needed it
Ease of getting a referral when you needed one

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* 2. OUR STAFF:

  Excellent Very Good Good Fair Poor N/A
The courtesy of the person who took your call
The friendliness and courtesy of the receptionist
The caring concern of our nurses/medical assistants
The helpfulness of the people who assisted you with billing or insurance

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* 3. OUR COMMUNICATION WITH YOU:

  Excellent Very Good Good Fair Poor N/A
Your phone calls answered promptly
Getting advice or help when needed during office hours
Your test results reported in a reasonable amount of time
Our ability to return calls in a timely manner
Your ability to obtain prescription refills by phone

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* 4. YOUR VISIT WITH THE PROVIDER:
(Doctor, Physician Assistant, Nurse Practitioner)

  Excellent Very Good Good Fair Poor N/A
Willingness to listen carefully to you
Taking time to answer your questions
Explaining things in a way you could understand
Instructions regarding medication/follow-up care
Advice given to you on ways to stay healthy

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* 5. Patient Portal:
Have you accessed your Patient Portal within the past 6 months?

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* 6. If yes, for what reason: (check all that apply)

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* 7. OUR FACILITY

  Excellent Very Good Good Fair Poor N/A
Hours of operation convenient for you
Overall comfort
Adequate parking
Signage and directions easy to follow

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* 8. YOUR OVERALL SATISFACTION WITH

  Excellent Very Good Good Fair Poor N/A
Our practice
The quality of your medical care
Overall rating of care from your provider or nurse

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* 9. Would you recommend the provider to others?

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* 10. Name of Practitioner that treated you

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* 11. Facility you visited (Home Visit - please indicate "home")

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* 12. Reason for visit

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* 13. Are our community resources appropriate for your needs?

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* 14. IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT

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* 15. SOME INFORMATION ABOUT YOU

  Under 18 18-30 31-40 41-50 51-60 Over 60
Male
Female

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* 16. Are you a

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* 17. Do you have Health Insurance?

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* 18. Name of Insurance Carrier

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