Patient Satisfaction Survey

Dear Patient: As part of our ongoing efforts to provide the highest quality service to our patients we are very interested in receiving your feedback about the care you received from our office. Please take a few minutes to complete this survey and return it to us. Your response is very important to us. Your answers will be kept confidential and all results will be aggregated and utilized to improve patient care. Thank you in advance for your help. 

Question Title

* 1. ACCESS TO THE CLINIC

  Very Satisfied Satisfied Not Satisfied or Dissatisfied Dissatisfied Very Dissatisfied N/A
Ease of making your appointment by telephone
Ability to get an appointment as quickly as you wanted it
Ability to be seen on the day and time that works best for you
The time that you spent in the waiting room and exam room before seeing your doctor

Question Title

* 2. OUR STAFF

  Very Satisfied Satisfied Not Satisfied or Dissatisfied Dissatisfied Very Dissatisfied N/A
The friendliness of the front desk staff
The caring and concern of the nurses/medical assistants

Question Title

* 3. COMMUNICATION

  Very Satisfied Satisfied Not Satisfied or Dissatisfied Dissatisfied Very Dissatisfied N/A
The speed with which your telephone calls are answered
Your ability to get help or advice during office hours by telephone
The way your doctor listened to your concerns and showed understanding of your health condition
Your doctor's explanation of things in a way you could understand
Ease of understanding instructions regarding your medication and follow-up care
The availability of your health information such as test results

Question Title

* 4. CARE COORDINATION

  Very Satisfied Satisfied Not Satisfied or Dissatisfied Dissatisfied Very Dissatisfied N/A
Your doctor's communication with other providers involved in your care
Your doctor's efforts to involve you in planning your own care
The quality and ease of use of the self-management tools given to you by the practice

Question Title

* 5. LIKELIHOOD TO RECOMMEND

  Would Definitely Recommend Would Recommend May or May Not Recommend Would Not Recommend Definitely Would Not Recommend
How likely are you to recommend our practice to your friends and family

Question Title

* 6. Please let us know the reasons you would or would not recommend our practice to others. 

Question Title

* 7. Please let us know if there is anything we can do to improve our services to you. 

Your answers are confidential, but please share some information with us to help us tailor our services better.

Question Title

* 8. Gender

Question Title

* 9. Age

Question Title

* 10. Primary Language

Question Title

* 11. Do you have health insurance:

Question Title

* 12. Thank you so much for providing us with this valuable information that we will use to improve your care. We are glad that you are our patient!

T