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Patient Survey

1.Who is your provider?

Branum, Joanna

Brogmus, Donna

Brown, Cara

Brown, Matt

Clang, Daniel

Clang, Tamara

Haskins, R Scott

Johnson, Kelly

Kennedy, Christopher

Lobitz, Paul

Magnuson, Douglas

Martinez, Matthew

Maurer, Chad

Morley, Erin

Nightengale, Heidi

Nwizu, Chima

Nwizu, Nnenna

Paczosa, Michelle

Pflieger, Daniel

Puls, Anna

Ruff, Joy

Samuelson, Scott

Sisneros, Drake

Waugh, Kyle

Wilson, D Craig

Young, Mark

2.What suggestions do you have to improve Family Physicians of Greeley?

3.What do you like most about Family Physicians of Greeley?

4.How do you rate the ease of scheduling an appointment?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

5.How do you rate our reception staff?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

6.How do you rate the wait time during your visits?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

7.How do you rate the physical environment of our office?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

8.How do you rate your doctor's medical assistant?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

9.How do you rate your doctor, overall?

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

10.Please rate your doctor on the following:

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Spending the right amount of time with you

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Making medical decisions in your best interest

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Explaining your medical condition

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Listening to you

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Following-up after your visit

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Helping you quickly when you need help

1 (Poor)

2

3 (Satisfactory)

4

5 (Excellent)

Comments

11.How likely are you to recommend Family Physicians of Greeley to family or friends?

Extremely likely

Very likely

Moderately likely

Slightly likely

Not at all likely

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