WPPS Patient Experience Survey

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* 1. Which category below includes your age?

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

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* 2. At which practice location is your primary care physician (PCP) located?

Woburn office

North Andover office

Other outside practice

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* 3. How satisfied were you with your last office visit with your behavioral health provider?

Extremely satisfied

Moderately satisfied

Slightly satisfied

Neither satisfied nor dissatisfied

Slightly dissatisfied

Moderately dissatisfied

Extremely dissatisfied

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* 4. Do you feel our office staff is kind, courteous, and helpful?

Yes

Sometimes

Needs Improvement

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* 5. How likely are you to recommend our practice to others?

Extremely likely

Very likely

Moderately likely

Slightly likely

Not at all likely

Why or why not? (please specify)

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* 6. What area of our office do you feel needs the most improvement?

	Outstanding	Average	Below Average	Needs Improvement
Phone Etiquette	Phone Etiquette Outstanding	Phone Etiquette Average	Phone Etiquette Below Average	Phone Etiquette Needs Improvement
Medical Provider Services	Medical Provider Services Outstanding	Medical Provider Services Average	Medical Provider Services Below Average	Medical Provider Services Needs Improvement
General Office Customer Service	General Office Customer Service Outstanding	General Office Customer Service Average	General Office Customer Service Below Average	General Office Customer Service Needs Improvement
Website	Website Outstanding	Website Average	Website Below Average	Website Needs Improvement
Referral & Billing Services	Referral & Billing Services Outstanding	Referral & Billing Services Average	Referral & Billing Services Below Average	Referral & Billing Services Needs Improvement
Appointment Scheduling	Appointment Scheduling Outstanding	Appointment Scheduling Average	Appointment Scheduling Below Average	Appointment Scheduling Needs Improvement

Other (please specify)

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* 7. Consider your visit(s) to our office in the last 6 months. Rate your experience for each of the following areas.

	Outstanding	Average	Below Average	Needs Improvement
Appointment obtained that worked with your schedule	Appointment obtained that worked with your schedule Outstanding	Appointment obtained that worked with your schedule Average	Appointment obtained that worked with your schedule Below Average	Appointment obtained that worked with your schedule Needs Improvement
Time spent in the waiting room prior to appointment	Time spent in the waiting room prior to appointment Outstanding	Time spent in the waiting room prior to appointment Average	Time spent in the waiting room prior to appointment Below Average	Time spent in the waiting room prior to appointment Needs Improvement
Time spent in the exam room waiting for the clinician	Time spent in the exam room waiting for the clinician Outstanding	Time spent in the exam room waiting for the clinician Average	Time spent in the exam room waiting for the clinician Below Average	Time spent in the exam room waiting for the clinician Needs Improvement
Coordination of care provided by your clinician to outside specialists/resources	Coordination of care provided by your clinician to outside specialists/resources Outstanding	Coordination of care provided by your clinician to outside specialists/resources Average	Coordination of care provided by your clinician to outside specialists/resources Below Average	Coordination of care provided by your clinician to outside specialists/resources Needs Improvement
Your clinician’s knowledge of the care received by outside specialists/resources	Your clinician’s knowledge of the care received by outside specialists/resources Outstanding	Your clinician’s knowledge of the care received by outside specialists/resources Average	Your clinician’s knowledge of the care received by outside specialists/resources Below Average	Your clinician’s knowledge of the care received by outside specialists/resources Needs Improvement

WPPS Patient Experience Survey

Question Title

* 1. Which category below includes your age?

Question Title

* 2. At which practice location is your primary care physician (PCP) located?

Question Title

* 3. How satisfied were you with your last office visit with your behavioral health provider?

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* 4. Do you feel our office staff is kind, courteous, and helpful?

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* 5. How likely are you to recommend our practice to others?

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* 6. What area of our office do you feel needs the most improvement?

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* 7. Consider your visit(s) to our office in the last 6 months. Rate your experience for each of the following areas.

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* 8. As a parent/guardian, what you would like us to be doing that we are not currently?

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* 9. How can we improve our practice as a whole?