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Post-Office Visit Patient Satisfaction Survey
1.
On a scale of 0 to 10,
How likely is it that you would recommend your doctor 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.
Which provider did you see at our office?
Dr. Michael Cox
Dr. David Cheng
Dr. Buffi Boyd
Jessica Letcher, FNP-BC
Madison Stewart, PA-C
Melissa Porter, PA-C
Dr. Stephen Michigan (father)
Dr. Andrew Michigan (son)
Dr. Ruth Ann Mazo
Dr. Thomas Shook
Dr. Heather Wallace
Other (please specify)
3.
Where did your office visit take place?
Statesboro
Savannah
4.
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
5.
How easy or difficult was it to schedule your appointment with our office?
Very easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Very difficult
6.
If you left a message for our office, how timely did we respond to your question/need?
Very timely
Timely
Not Timely
Additional comments regarding office response to your questions/needs:
7.
Overall, how would you rate the service you received from the staff at our office?
Excellent
Very good
Good
Fair
Poor
8.
How comfortable and presentable was the lobby and waiting area?
Extremely comfortable
Very comfortable
Somewhat comfortable
Not so comfortable
Not at all comfortable
Additional comments regarding our lobby/waiting area:
9.
Did your appointment with your provider start early, late or on time?
Very early
Somewhat early
On time
Somewhat late
Very late
10.
Overall, how would you rate the care you received from your provider?
Excellent
Very good
Good
Fair
Poor
11.
How much do you trust your provider to make medical decisions that are in your best interests?
A great deal
A lot
A moderate amount
A little
Not at all
12.
How well did your provider listen to your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
13.
How well did your provider answer your questions?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
14.
How well did your provider explain your treatment options?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
Not applicable (n/a)
15.
How well did your provider explain your follow-up care?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
No follow-up needed (not applicable)
16.
How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
17.
Is there anything we could have done to improve your last visit?
18.
What is your name (optional) - please include if you have left comments that might require our feedback/response?
