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Patient Feedback Survey - Arroyo Vista Family Medicine
1.
How satisfied are you with?:
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments)
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Ease of making same-day/sick visit appointments?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
The time it takes someone from our office to respond when you call the office with an urgent problem?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Waiting time in our office?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Ease in obtaining follow-up information and care (test results, medicines, care instructions)?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Overall medical care at your doctor’s office?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Our office’s appearance?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
The way we teach you about improving your health?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
The way your doctor involves other doctors and caregivers in your care when needed?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Please offer any specific feedback here for any item(s) you are
Very Dissatisfied
or
Extremely Dissatisfied
about:
2.
How caring would you say the following individuals are?:
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Your doctor?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Our medical staff (medical assistants, nurses, etc.)?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Our front office staff?
Extremely Dissatisfied
Very Dissatisfied
Somewhat Dissatisfied
Satisfied
Very Satisfied
Extremely Satisfied
Please offer any specific feedback here for any item(s) you are
Very Dissatisfied or
Extremely Dissatisfied
about:
3.
Overall Satisfaction
Yes
No
Maybe
Would your recommend Arroyo Vista Family Medicine to your family or friends?
Yes
No
Maybe
Would your recommend Dr. Landero to your family or friends?
Yes
No
Maybe
Please offer any specific feedback here for any item(s) you answered
No
or
Maybe
to:
4.
At Arroyo Vista Family Medicine, we strive to continuously improve ourselves in an effort to improve quality of care and the overall patient experience. Please take a moment to give us specific feedback in areas we could grow in. Your feedback is greatly appreciated!
5.
OPTIONAL
-
I
F
you would like for us to get back to you regarding your answers on this survey, please provide us with your contact information below:
Name:
Best Contact Number:
Best Time(s) To Call:
Current Progress,
0 of 5 answered