www.miramont.us Miramont Patient Survey Question Title * 1. Who was your provider today? John L Bender, M.D. Kelly Lowther, M.D. Doug DeYoung, D.O. Prema Jacob, MD Donald Dickman, MD Ray Quenneville, PA-C Lindsey Johannsen, FNP Annie Stavros, PA-C Lisa Hammond, FNP Samantha Davis, FNP-C Amanda Dollar, RN Other (please specify) Question Title * 2. Did you see the provider that you wanted to see today? Yes No It did not matter Question Title * 3. How would you rate the length of time you waited to get this appointment? Excellent Very Good Good Fair Poor Other (please specify) Question Title * 4. How would you rate your waiting time for today's visit? Excellent Very Good Good Fair Poor Question Title * 5. How would you rate your experience getting through to Miramont Family Medicine by phone? Excellent Very Good Good Fair Poor Other (please specify) Question Title * 6. Compared to other offices, the quality of care at Miramont Family Medicine is...? Much Better Better Same Worse Much Worse Not Sure Other (please specify) Question Title * 7. Based on your telephone contacts with Miramont Family Medicine over the past few months, how easy has it been for you to do the following? Very difficult Difficult Easy Very Easy Make appointments? Make appointments? Very difficult Make appointments? Difficult Make appointments? Easy Make appointments? Very Easy Get prescriptions refilled? Get prescriptions refilled? Very difficult Get prescriptions refilled? Difficult Get prescriptions refilled? Easy Get prescriptions refilled? Very Easy Get lab results? Get lab results? Very difficult Get lab results? Difficult Get lab results? Easy Get lab results? Very Easy Talk to a nurse or medical assistant? Talk to a nurse or medical assistant? Very difficult Talk to a nurse or medical assistant? Difficult Talk to a nurse or medical assistant? Easy Talk to a nurse or medical assistant? Very Easy Talk to your physician or provider? Talk to your physician or provider? Very difficult Talk to your physician or provider? Difficult Talk to your physician or provider? Easy Talk to your physician or provider? Very Easy Other (please specify) Question Title * 8. I would recommend Miramont Family Medicine to my family and friends. Definitely Yes Maybe Definitely No Not Sure Other (please specify) Question Title * 9. What do we need to know to improve our customer service? Done
