Confidential Patient Survey

* 1. The receptionist greeted me promptly?

1 Strongly disagree

2 Disagree

3 Neutral

4 Agree

5 Strongly Agree

1 Strongly disagree

2 Disagree

3 Neutral

4 Agree

5 Strongly Agree

Other (please specify)

* 2. The receptionist treated me with kindness and respect?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 3. How could we make the wait time more comfortable?

* 4. The nursing staff treated me with kindness and respect?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 5. The nursing staff was responsive to my needs?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 6. The physician was willing to listen to my concerns?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 7. How could we improve the care you received from our Physician and nursing staff?

* 8. Overall neatness and cleanliness of our facility?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 9. Overall, I had a positive experience with Argyll Medical Group?

1

2

3

4

5

1

2

3

4

5

Other (please specify)

* 10. Additional comments or suggestions.