Dear Patient: Our goal is to provide comfort, convenience, and satisfaction as well as the very best medical care to all our patients. We'd like to know how you feel about our medical services, our patient-handling systems, our physicians and our staff members. Your comments will be kept confidential, and will help us evaluate our operations to ensure that we are truly responsible to your needs. Thank you for your help.
When was your most recent visit to the Touro Health Center?

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* 1. When was your most recent visit to the Touro Health Center?

YOUR APPOINTMENT:
Please rate the following:

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* 2. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Ease of making appointments by phone
Appointment available within a reasonable amount of time
Getting after-hours care when you needed it
The efficiency of the check-in process
Waiting time in the reception area
Waiting time in the exam room
Ease of getting a referral when you needed one
OUR STAFF:
Please rate the following:

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* 3. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
The courtesy of the person who took your call
The friendliness and courtesy of the receptionist/office staff
The helpfulness of the receptionist/office staff
Keeping you informed if your appointment time was delayed
The caring concern of our nurses/medical assistants
OUR COMMUNICATION WITH YOU:
Please rate the following:

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* 4. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Your phone calls answered promptly
Clear and concise phone communications
Getting advice or help when needed during office hours
Answering your questions in a way that was easy to understand
Your test results reported in a reasonable amount of time
Effectiveness of our patient education materials
Your phone calls are returned in a timely manner
Your ability to contact us after hours
Your ability to obtain prescription refills
YOUR VISIT WITH THE PROVIDER (DOCTOR, PHYSICIAN ASSISTANT, NURSE PRACTITIONER):
Please rate the following:

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* 5. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Willingness to listen carefully to you
Taking time to answer your questions
Amount of time spent with you
Explaining things in a way you could understand
Instructions regarding medication/follow-up care
The thoroughness of the examination
Knowledge of important information about your medical history
Showing respect for what you had to say
Including you in decision-making about your treatment plan
BILLING:
Thinking of your most recent billing-related interaction, please rate the following:

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* 6. Thinking of your most recent billing-related interaction, please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Clarity of your billing statement
Accuracy of the billing statement
Helpfulness of people who assisted you with billing/insurance
Promptness in resolving billing/insurance questions or problems
OUR FACILITY:
Please rate the following:

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* 7. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Hours of operation convenient for you
Overall comfort
Adequate parking
Signage and directions easy to follow
YOUR OVERALL SATISFACTION WITH:
Please rate the following:

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* 8. Please rate the following:

  Excellent Very Good Good Fair Poor Does Not Apply
Your overall satisfaction
The quality of your medical care
Overall rating of care from your provider
Would you recommend the provider to others?

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* 9. Would you recommend the provider to others?

If you answered "Probably Not" or "Definitely Not" please tell us why:

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* 10. If you answered "Probably Not" or "Definitely Not" please tell us why:

If there is any way we can improve our services to you, please tell us about it:

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* 11. If there is any way we can improve our services to you, please tell us about it:

How did you originally hear about us?

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* 12. How did you originally hear about us?

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