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Post-Visit Patient Satisfaction Template
1.
On a scale of 0 to 10,
How likely is it that you would recommend Northern Neighbours NPLC to a friend or family member?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
2.
Overall, how satisfied or dissatisfied were you with your last visit to our office?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
3.
How easy or difficult was it to schedule your appointment at a time that was convenient for you?
Very easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Very difficult
4.
How convenient was the appointment time you were able to get?
Extremely convenient
Very convenient
Somewhat convenient
Not so convenient
Not at all convenient
5.
In your opinion, how convenient is the location of our office?
Extremely convenient
Very convenient
Somewhat convenient
Not so convenient
Not at all convenient
6.
Overall, how would you rate the service you received from the staff at our office?
Excellent
Very good
Good
Fair
Poor
7.
Did your appointment with Northern Neighbours NPLC start early, late or on time?
Very early
Somewhat early
On time
Somewhat late
Very late
8.
Overall, how would you rate the care you received from Northern Neighbours NPLC?
Excellent
Very good
Good
Fair
Poor
9.
How much do you trust Northern Neighbours NPLC to make medical decisions that are in your best interests?
A great deal
A lot
A moderate amount
A little
Not at all
10.
How well did Northern Neighbours NPLC listen to your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
11.
How well did Northern Neighbours NPLC answer your questions?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
12.
How well did Northern Neighbours NPLC explain your treatment options?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
13.
How satisfied or dissatisfied were you with the amount of time Northern Neighbours NPLC spent with you addressing your needs?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
14.
Is there anything we could have done to improve your last visit?
Current Progress,
0 of 14 answered