Patient Satisfaction Survey Question Title * 1. How would you rate your appointment? Very Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Very Satisfied Ease of making appointment Ease of making appointment Very Dissatisfied Ease of making appointment Somewhat Dissatisfied Ease of making appointment Neutral Ease of making appointment Somewhat Satisfied Ease of making appointment Very Satisfied Appointment made within reasonable amount of time Appointment made within reasonable amount of time Very Dissatisfied Appointment made within reasonable amount of time Somewhat Dissatisfied Appointment made within reasonable amount of time Neutral Appointment made within reasonable amount of time Somewhat Satisfied Appointment made within reasonable amount of time Very Satisfied Efficiency/Ease of check in Efficiency/Ease of check in Very Dissatisfied Efficiency/Ease of check in Somewhat Dissatisfied Efficiency/Ease of check in Neutral Efficiency/Ease of check in Somewhat Satisfied Efficiency/Ease of check in Very Satisfied Waiting time in reception area Waiting time in reception area Very Dissatisfied Waiting time in reception area Somewhat Dissatisfied Waiting time in reception area Neutral Waiting time in reception area Somewhat Satisfied Waiting time in reception area Very Satisfied Waiting time in exam room Waiting time in exam room Very Dissatisfied Waiting time in exam room Somewhat Dissatisfied Waiting time in exam room Neutral Waiting time in exam room Somewhat Satisfied Waiting time in exam room Very Satisfied Keeping you informed if your appointment was delayed Keeping you informed if your appointment was delayed Very Dissatisfied Keeping you informed if your appointment was delayed Somewhat Dissatisfied Keeping you informed if your appointment was delayed Neutral Keeping you informed if your appointment was delayed Somewhat Satisfied Keeping you informed if your appointment was delayed Very Satisfied Question Title * 2. How would you rate our support staff? Very Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Very Satisfied Courtesy of person whom took your call Courtesy of person whom took your call Very Dissatisfied Courtesy of person whom took your call Somewhat Dissatisfied Courtesy of person whom took your call Neutral Courtesy of person whom took your call Somewhat Satisfied Courtesy of person whom took your call Very Satisfied Friendliness and courtesy of the front desk staff Friendliness and courtesy of the front desk staff Very Dissatisfied Friendliness and courtesy of the front desk staff Somewhat Dissatisfied Friendliness and courtesy of the front desk staff Neutral Friendliness and courtesy of the front desk staff Somewhat Satisfied Friendliness and courtesy of the front desk staff Very Satisfied Care/concern of our nurses/medical assistant Care/concern of our nurses/medical assistant Very Dissatisfied Care/concern of our nurses/medical assistant Somewhat Dissatisfied Care/concern of our nurses/medical assistant Neutral Care/concern of our nurses/medical assistant Somewhat Satisfied Care/concern of our nurses/medical assistant Very Satisfied Customer service you received from support staff Customer service you received from support staff Very Dissatisfied Customer service you received from support staff Somewhat Dissatisfied Customer service you received from support staff Neutral Customer service you received from support staff Somewhat Satisfied Customer service you received from support staff Very Satisfied Question Title * 3. How would you rate our communication with you? Very Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Very Satisfied Your test/lab results reported in a reasonable amount of time Your test/lab results reported in a reasonable amount of time Very Dissatisfied Your test/lab results reported in a reasonable amount of time Somewhat Dissatisfied Your test/lab results reported in a reasonable amount of time Neutral Your test/lab results reported in a reasonable amount of time Somewhat Satisfied Your test/lab results reported in a reasonable amount of time Very Satisfied Our ability to return your calls in a timely manner Our ability to return your calls in a timely manner Very Dissatisfied Our ability to return your calls in a timely manner Somewhat Dissatisfied Our ability to return your calls in a timely manner Neutral Our ability to return your calls in a timely manner Somewhat Satisfied Our ability to return your calls in a timely manner Very Satisfied Your ability to contact us after hours Your ability to contact us after hours Very Dissatisfied Your ability to contact us after hours Somewhat Dissatisfied Your ability to contact us after hours Neutral Your ability to contact us after hours Somewhat Satisfied Your ability to contact us after hours Very Satisfied Your ability to obtain prescription refills Your ability to obtain prescription refills Very Dissatisfied Your ability to obtain prescription refills Somewhat Dissatisfied Your ability to obtain prescription refills Neutral Your ability to obtain prescription refills Somewhat Satisfied Your ability to obtain prescription refills Very Satisfied Question Title * 4. How would you rate your visit from our providers? Very Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Very Satisfied Willingness to listen carefully to you Willingness to listen carefully to you Very Dissatisfied Willingness to listen carefully to you Somewhat Dissatisfied Willingness to listen carefully to you Neutral Willingness to listen carefully to you Somewhat Satisfied Willingness to listen carefully to you Very Satisfied Taking time to answer questions Taking time to answer questions Very Dissatisfied Taking time to answer questions Somewhat Dissatisfied Taking time to answer questions Neutral Taking time to answer questions Somewhat Satisfied Taking time to answer questions Very Satisfied Explaining things in a way you could understand Explaining things in a way you could understand Very Dissatisfied Explaining things in a way you could understand Somewhat Dissatisfied Explaining things in a way you could understand Neutral Explaining things in a way you could understand Somewhat Satisfied Explaining things in a way you could understand Very Satisfied Thoroughness of the examination Thoroughness of the examination Very Dissatisfied Thoroughness of the examination Somewhat Dissatisfied Thoroughness of the examination Neutral Thoroughness of the examination Somewhat Satisfied Thoroughness of the examination Very Satisfied Advice given to you on ways to stay healthy Advice given to you on ways to stay healthy Very Dissatisfied Advice given to you on ways to stay healthy Somewhat Dissatisfied Advice given to you on ways to stay healthy Neutral Advice given to you on ways to stay healthy Somewhat Satisfied Advice given to you on ways to stay healthy Very Satisfied Question Title * 5. How would you rate our practice? Very Dissatisfied Somewhat Dissatisfied Neutral Somewhat Satisfied Very Satisfied Convenient hours of operation Convenient hours of operation Very Dissatisfied Convenient hours of operation Somewhat Dissatisfied Convenient hours of operation Neutral Convenient hours of operation Somewhat Satisfied Convenient hours of operation Very Satisfied Cleanliness and general appearance of the office Cleanliness and general appearance of the office Very Dissatisfied Cleanliness and general appearance of the office Somewhat Dissatisfied Cleanliness and general appearance of the office Neutral Cleanliness and general appearance of the office Somewhat Satisfied Cleanliness and general appearance of the office Very Satisfied Overall satisfaction Overall satisfaction Very Dissatisfied Overall satisfaction Somewhat Dissatisfied Overall satisfaction Neutral Overall satisfaction Somewhat Satisfied Overall satisfaction Very Satisfied Our practice Our practice Very Dissatisfied Our practice Somewhat Dissatisfied Our practice Neutral Our practice Somewhat Satisfied Our practice Very Satisfied Quality of your medical care Quality of your medical care Very Dissatisfied Quality of your medical care Somewhat Dissatisfied Quality of your medical care Neutral Quality of your medical care Somewhat Satisfied Quality of your medical care Very Satisfied Question Title * 6. Which provider do you see primarily? Dr. Perkins Dr. Whitlock Jessica French, CPNP Kirsten Coulter, CPNP Question Title * 7. Overall, how would you rate each of our providers? Very Satisfied Somewhat Satisfied Neutral-Neither Satisfied or Dissatisfied Somewhat Dissatisfied Very Dissatisfied N/A-I have never seen this provider Cheryl Perkins, MD Cheryl Perkins, MD Very Satisfied Cheryl Perkins, MD Somewhat Satisfied Cheryl Perkins, MD Neutral-Neither Satisfied or Dissatisfied Cheryl Perkins, MD Somewhat Dissatisfied Cheryl Perkins, MD Very Dissatisfied Cheryl Perkins, MD N/A-I have never seen this provider P. Austin Whitlock, III, MD P. Austin Whitlock, III, MD Very Satisfied P. Austin Whitlock, III, MD Somewhat Satisfied P. Austin Whitlock, III, MD Neutral-Neither Satisfied or Dissatisfied P. Austin Whitlock, III, MD Somewhat Dissatisfied P. Austin Whitlock, III, MD Very Dissatisfied P. Austin Whitlock, III, MD N/A-I have never seen this provider Kirsten Coulter, CPNP Kirsten Coulter, CPNP Very Satisfied Kirsten Coulter, CPNP Somewhat Satisfied Kirsten Coulter, CPNP Neutral-Neither Satisfied or Dissatisfied Kirsten Coulter, CPNP Somewhat Dissatisfied Kirsten Coulter, CPNP Very Dissatisfied Kirsten Coulter, CPNP N/A-I have never seen this provider Jessica French, CPNP Jessica French, CPNP Very Satisfied Jessica French, CPNP Somewhat Satisfied Jessica French, CPNP Neutral-Neither Satisfied or Dissatisfied Jessica French, CPNP Somewhat Dissatisfied Jessica French, CPNP Very Dissatisfied Jessica French, CPNP N/A-I have never seen this provider Question Title * 8. Would you recommend our practice to others? Yes No Other (please specify) Question Title * 9. In what ways can we improve our practice? Question Title * 10. Can we contact you regarding the information you provided? Name Phone Number Done