Patients Satisfaction Survey

We would like to know how you feel about the services we provde so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

	Great	Good	OK	Fair	Poor
Ability to get in to be seen	Ability to get in to be seen Great	Ability to get in to be seen Good	Ability to get in to be seen OK	Ability to get in to be seen Fair	Ability to get in to be seen Poor
Hours Center is open	Hours Center is open Great	Hours Center is open Good	Hours Center is open OK	Hours Center is open Fair	Hours Center is open Poor
Convenience of Center's location	Convenience of Center's location Great	Convenience of Center's location Good	Convenience of Center's location OK	Convenience of Center's location Fair	Convenience of Center's location Poor
Prompt return on calls	Prompt return on calls Great	Prompt return on calls Good	Prompt return on calls OK	Prompt return on calls Fair	Prompt return on calls Poor

Great

Good

Fair

Poor

Ability to get in to be seen

Ability to get in to be seen Great

Ability to get in to be seen Good

Ability to get in to be seen OK

Ability to get in to be seen Fair

Ability to get in to be seen Poor

Hours Center is open

Hours Center is open Great

Hours Center is open Good

Hours Center is open OK

Hours Center is open Fair

Hours Center is open Poor

Convenience of Center's location

Convenience of Center's location Great

Convenience of Center's location Good

Convenience of Center's location OK

Convenience of Center's location Fair

Convenience of Center's location Poor

Prompt return on calls

Prompt return on calls Great

Prompt return on calls Good

Prompt return on calls OK

Prompt return on calls Fair

Prompt return on calls Poor

	Great	Good	OK	Fair	Poor
Time in waiting room	Time in waiting room Great	Time in waiting room Good	Time in waiting room OK	Time in waiting room Fair	Time in waiting room Poor
Time in exam room	Time in exam room Great	Time in exam room Good	Time in exam room OK	Time in exam room Fair	Time in exam room Poor
Waiting for tests to be performed	Waiting for tests to be performed Great	Waiting for tests to be performed Good	Waiting for tests to be performed OK	Waiting for tests to be performed Fair	Waiting for tests to be performed Poor
Waiting for test results	Waiting for test results Great	Waiting for test results Good	Waiting for test results OK	Waiting for test results Fair	Waiting for test results Poor

Great

Good

Fair

Poor

Time in waiting room

Time in waiting room Great

Time in waiting room Good

Time in waiting room OK

Time in waiting room Fair

Time in waiting room Poor

Time in exam room

Time in exam room Great

Time in exam room Good

Time in exam room OK

Time in exam room Fair

Time in exam room Poor

Waiting for tests to be performed

Waiting for tests to be performed Great

Waiting for tests to be performed Good

Waiting for tests to be performed OK

Waiting for tests to be performed Fair

Waiting for tests to be performed Poor

Waiting for test results

Waiting for test results Great

Waiting for test results Good

Waiting for test results OK

Waiting for test results Fair

Waiting for test results Poor

	Great	Good	OK	Fair	Poor
Listens to you	Listens to you Great	Listens to you Good	Listens to you OK	Listens to you Fair	Listens to you Poor
Takes enough time with you	Takes enough time with you Great	Takes enough time with you Good	Takes enough time with you OK	Takes enough time with you Fair	Takes enough time with you Poor
Explains what you want to know	Explains what you want to know Great	Explains what you want to know Good	Explains what you want to know OK	Explains what you want to know Fair	Explains what you want to know Poor
Gives you good advice and treatment	Gives you good advice and treatment Great	Gives you good advice and treatment Good	Gives you good advice and treatment OK	Gives you good advice and treatment Fair	Gives you good advice and treatment Poor

Great

Good

Fair

Poor

Listens to you

Listens to you Great

Listens to you Good

Listens to you OK

Listens to you Fair

Listens to you Poor

Takes enough time with you

Takes enough time with you Great

Takes enough time with you Good

Takes enough time with you OK

Takes enough time with you Fair

Takes enough time with you Poor

Explains what you want to know

Explains what you want to know Great

Explains what you want to know Good

Explains what you want to know OK

Explains what you want to know Fair

Explains what you want to know Poor

Gives you good advice and treatment

Gives you good advice and treatment Great

Gives you good advice and treatment Good

Gives you good advice and treatment OK

Gives you good advice and treatment Fair

Gives you good advice and treatment Poor

	Great	Good	OK	Fair	Poor
Friendly and helpful to you	Friendly and helpful to you Great	Friendly and helpful to you Good	Friendly and helpful to you OK	Friendly and helpful to you Fair	Friendly and helpful to you Poor
Answers your questions	Answers your questions Great	Answers your questions Good	Answers your questions OK	Answers your questions Fair	Answers your questions Poor

Great

Good

Fair

Poor

Friendly and helpful to you

Friendly and helpful to you Great

Friendly and helpful to you Good

Friendly and helpful to you OK

Friendly and helpful to you Fair

Friendly and helpful to you Poor

Answers your questions

Answers your questions Great

Answers your questions Good

Answers your questions OK

Answers your questions Fair

Answers your questions Poor

	Great	Good	OK	Fair	Poor
Friendly and helpful to you	Friendly and helpful to you Great	Friendly and helpful to you Good	Friendly and helpful to you OK	Friendly and helpful to you Fair	Friendly and helpful to you Poor
Answers your questions	Answers your questions Great	Answers your questions Good	Answers your questions OK	Answers your questions Fair	Answers your questions Poor

Great

Good

Fair

Poor

Friendly and helpful to you

Friendly and helpful to you Great

Friendly and helpful to you Good

Friendly and helpful to you OK

Friendly and helpful to you Fair

Friendly and helpful to you Poor

Answers your questions

Answers your questions Great

Answers your questions Good

Answers your questions OK

Answers your questions Fair

Answers your questions Poor

	Great	Good	OK	Fair	Poor
What you pay	What you pay Great	What you pay Good	What you pay OK	What you pay Fair	What you pay Poor
Explanation of charges	Explanation of charges Great	Explanation of charges Good	Explanation of charges OK	Explanation of charges Fair	Explanation of charges Poor
Collection of payment/money	Collection of payment/money Great	Collection of payment/money Good	Collection of payment/money OK	Collection of payment/money Fair	Collection of payment/money Poor

Great

Good

Fair

Poor

What you pay

What you pay Great

What you pay Good

What you pay OK

What you pay Fair

What you pay Poor

Explanation of charges

Explanation of charges Great

Explanation of charges Good

Explanation of charges OK

Explanation of charges Fair

Explanation of charges Poor

Collection of payment/money

Collection of payment/money Great

Collection of payment/money Good

Collection of payment/money OK

Collection of payment/money Fair

Collection of payment/money Poor

	Great	Good	OK	Fair	Poor
Neat and clean building	Neat and clean building Great	Neat and clean building Good	Neat and clean building OK	Neat and clean building Fair	Neat and clean building Poor
Ease of finding where to go	Ease of finding where to go Great	Ease of finding where to go Good	Ease of finding where to go OK	Ease of finding where to go Fair	Ease of finding where to go Poor
Comfort and Safety while waiting	Comfort and Safety while waiting Great	Comfort and Safety while waiting Good	Comfort and Safety while waiting OK	Comfort and Safety while waiting Fair	Comfort and Safety while waiting Poor
Privacy	Privacy Great	Privacy Good	Privacy OK	Privacy Fair	Privacy Poor

Great

Good

Fair

Poor

Neat and clean building

Neat and clean building Great

Neat and clean building Good

Neat and clean building OK

Neat and clean building Fair

Neat and clean building Poor

Ease of finding where to go

Ease of finding where to go Great

Ease of finding where to go Good

Ease of finding where to go OK

Ease of finding where to go Fair

Ease of finding where to go Poor

Comfort and Safety while waiting

Comfort and Safety while waiting Great

Comfort and Safety while waiting Good

Comfort and Safety while waiting OK

Comfort and Safety while waiting Fair

Comfort and Safety while waiting Poor

Privacy

Privacy Great

Privacy Good

Privacy OK

Privacy Fair

Privacy Poor

	Great	Good	OK	Fair	Poor
Keeping my personal information private	Keeping my personal information private Great	Keeping my personal information private Good	Keeping my personal information private OK	Keeping my personal information private Fair	Keeping my personal information private Poor
The likehood of referring your friends and relatives to us	The likehood of referring your friends and relatives to us Great	The likehood of referring your friends and relatives to us Good	The likehood of referring your friends and relatives to us OK	The likehood of referring your friends and relatives to us Fair	The likehood of referring your friends and relatives to us Poor

Great

Good

Fair

Poor

Keeping my personal information private

Keeping my personal information private Great

Keeping my personal information private Good

Keeping my personal information private OK

Keeping my personal information private Fair

Keeping my personal information private Poor

The likehood of referring your friends and relatives to us

The likehood of referring your friends and relatives to us Great

The likehood of referring your friends and relatives to us Good

The likehood of referring your friends and relatives to us OK

The likehood of referring your friends and relatives to us Fair

The likehood of referring your friends and relatives to us Poor

Patients Satisfaction Survey - Website

Question Title

* 1. Your Age:

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* 2. Your Sex:

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* 3. Your Race/Ethnicity:

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* 4. Ease of Getting Care:

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* 5. Waiting

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* 6. Staff"
(Provider: (physician, Dentist, Physician Assistant, Nurse Practitioner)

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* 7. Nurses and Medical Assistants:

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* 8. All Others

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* 9. Payment:

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* 10. Facility:

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* 11. Confidentiality:

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* 12. Do you consider this center your regular source of care:

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* 13. What is the name of your doctor/practioner?

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* 14. What do you like best about our center?

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* 15. What do you like least about our center?

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* 16. Suggestions for improvement:

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* 1. Your Age:

Question Title

* 2. Your Sex:

Question Title

* 3. Your Race/Ethnicity:

Question Title

* 4. Ease of Getting Care:

Question Title

* 5. Waiting

Question Title

* 6. Staff" (Provider: (physician, Dentist, Physician Assistant, Nurse Practitioner)

Question Title

* 7. Nurses and Medical Assistants:

Question Title

* 8. All Others

Question Title

* 9. Payment:

Question Title

* 10. Facility:

Question Title

* 11. Confidentiality:

Question Title

* 12. Do you consider this center your regular source of care:

Question Title

* 13. What is the name of your doctor/practioner?

Question Title

* 14. What do you like best about our center?

Question Title

* 15. What do you like least about our center?

Question Title

* 16. Suggestions for improvement:

* 6. Staff"
(Provider: (physician, Dentist, Physician Assistant, Nurse Practitioner)