Post-Visit Patient Satisfaction Template Question Title * 1. 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 OK Question Title * 2. How easy or difficult was it to schedule your appointment at a time that was convenient for you? Very easy Somewhat easy Neither easy nor difficult Somewhat difficult Very difficult Not applicable (the appointment was made for me) OK Question Title * 3. How convenient was the appointment time you were able to get? Extremely convenient Very convenient Somewhat convenient Not so convenient Not at all convenient OK Question Title * 4. In your opinion, how convenient is the location of our office? Extremely convenient Very convenient Somewhat convenient Not so convenient Not at all convenient OK Question Title * 5. Overall, how would you rate the service you received from the staff at our office? Excellent Very good Good Fair Poor OK Question Title * 6. How comfortable was the waiting area? Extremely comfortable Very comfortable Somewhat comfortable Not so comfortable Not at all comfortable OK Question Title * 7. Did your appointment with your provider start early, late or on time? Very early Somewhat early On time Somewhat late Very late OK Question Title * 8. Overall, how would you rate the consultation you had with the doctor or nurse at Independent Medical Services? Excellent Very good Good Fair Poor OK Question Title * 9. How much do you trust Independent Medical Services to make medical decisions that are in your best interests? A great deal A lot A moderate amount A little Not at all OK Question Title * 10. How well did the doctor or nurse listen to you during the consultation? Extremely well Very well Somewhat well Not so well Not at all well OK Question Title * 11. How well did the doctor or nurse answer your questions? Extremely well Very well Somewhat well Not so well Not at all well OK Question Title * 12. If you attended for an Occupational Health assessment, how well did the doctor explain the purpose of the assessment? Extremely well Very well Somewhat well Not so well Not at all well Not applicable - this wasn't an Occupational Health assessment OK Question Title * 13. If you attended for an Occupational Health assessment, how well did the doctor explain the consent process for the release of a report to your employer? Very well Quite well Not very well Badly Not applicable - this wasn't an Occupational Health assessment OK Question Title * 14. Is there anything we could have done to improve your last visit? OK DONE