Customer satisfaction BPHS and SMS

We appreciate your business!

Please let us know how we are doing.

Here at Bangor Plastic & Hand Surgery and Surface Medical Spa our goal is to provide patients with exceptional care in a friendly and professional environment. We are committed to patient satisfaction and rely on your feedback to continuously improve our services. Please take a few minutes to fill out this survey on the quality of the service(s) you received today. Thank you for your participation.

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* 1. Please rate the following on a scale 0-5

	0 Very Poor	1	2	3	4	5 Excellent
Scheduling of your appointment	Scheduling of your appointment 0 Very Poor	Scheduling of your appointment 1	Scheduling of your appointment 2	Scheduling of your appointment 3	Scheduling of your appointment 4	Scheduling of your appointment 5 Excellent
Phone Access	Phone Access 0 Very Poor	Phone Access 1	Phone Access 2	Phone Access 3	Phone Access 4	Phone Access 5 Excellent
Friendliness of our receptionist	Friendliness of our receptionist 0 Very Poor	Friendliness of our receptionist 1	Friendliness of our receptionist 2	Friendliness of our receptionist 3	Friendliness of our receptionist 4	Friendliness of our receptionist 5 Excellent
Promptness of our receptionist	Promptness of our receptionist 0 Very Poor	Promptness of our receptionist 1	Promptness of our receptionist 2	Promptness of our receptionist 3	Promptness of our receptionist 4	Promptness of our receptionist 5 Excellent
Professionalism of your provider(s)	Professionalism of your provider(s) 0 Very Poor	Professionalism of your provider(s) 1	Professionalism of your provider(s) 2	Professionalism of your provider(s) 3	Professionalism of your provider(s) 4	Professionalism of your provider(s) 5 Excellent
Follow-up care	Follow-up care 0 Very Poor	Follow-up care 1	Follow-up care 2	Follow-up care 3	Follow-up care 4	Follow-up care 5 Excellent
Accessibility of provider	Accessibility of provider 0 Very Poor	Accessibility of provider 1	Accessibility of provider 2	Accessibility of provider 3	Accessibility of provider 4	Accessibility of provider 5 Excellent
Treatment goals are being/were met	Treatment goals are being/were met 0 Very Poor	Treatment goals are being/were met 1	Treatment goals are being/were met 2	Treatment goals are being/were met 3	Treatment goals are being/were met 4	Treatment goals are being/were met 5 Excellent
Office Environment	Office Environment 0 Very Poor	Office Environment 1	Office Environment 2	Office Environment 3	Office Environment 4	Office Environment 5 Excellent

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* 2. How long did you wait in the reception area beyond your scheduled appointment time?

0 to 5 minutes

5 to 20 minutes

20 to 40 minutes

40 minutes +

Other (please specify)

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* 3. How long did you wait in the exam/treatment room before the physician appeared?

0 to 5 minutes

5 to 20 minutes

20 to 40 minutes

40 minutes +

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* 4. Did you feel that your provider spent an adequate amount of time with you?

Yes

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* 5. Mark the boxes that characterize the demeanor of your provider:

Attentive

Concerned

Friendly

Distracted

Rushed

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* 6. Were your questions answered to your satisfaction?

Yes

N/A

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* 7. Did you feel your privacy was respected?

Yes

Other (please specify)

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* 8. Would you recommend this facility and its staff to your family and friends?

Yes

Other (please specify)

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* 9. Please list any areas in which our services can be improved.

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* 10. Contact information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number