Emergency Physicians Medical Center Satisfaction Survey DATE OF SERVICE / / Question Title * 1. Registration Process: Excellent Good Fair Poor Made to feel welcome on arrival Made to feel welcome on arrival Excellent Made to feel welcome on arrival Good Made to feel welcome on arrival Fair Made to feel welcome on arrival Poor Courtesy of the person who checked you in Courtesy of the person who checked you in Excellent Courtesy of the person who checked you in Good Courtesy of the person who checked you in Fair Courtesy of the person who checked you in Poor Question Title * 2. Which Doctor did you see? Dr. Dan Dickinson Dr. Donald Janes Dr. James Young Dr. Steven Yucht Question Title * 3. The Doctor: Excellent Good Fair Poor N/A Listened carefully to you Listened carefully to you Excellent Listened carefully to you Good Listened carefully to you Fair Listened carefully to you Poor Listened carefully to you N/A Spent enough time with you Spent enough time with you Excellent Spent enough time with you Good Spent enough time with you Fair Spent enough time with you Poor Spent enough time with you N/A Used language you could understand Used language you could understand Excellent Used language you could understand Good Used language you could understand Fair Used language you could understand Poor Used language you could understand N/A Explained results of any testing done Explained results of any testing done Excellent Explained results of any testing done Good Explained results of any testing done Fair Explained results of any testing done Poor Explained results of any testing done N/A Gave you valuable advice and treatment Gave you valuable advice and treatment Excellent Gave you valuable advice and treatment Good Gave you valuable advice and treatment Fair Gave you valuable advice and treatment Poor Gave you valuable advice and treatment N/A Treated you with respect and compassion Treated you with respect and compassion Excellent Treated you with respect and compassion Good Treated you with respect and compassion Fair Treated you with respect and compassion Poor Treated you with respect and compassion N/A Answered your questions Answered your questions Excellent Answered your questions Good Answered your questions Fair Answered your questions Poor Answered your questions N/A Other (please specify) Question Title * 4. Which Staff Members helped you? Check all that apply. Amie Angie AnnMarie Autumn Brendan Casey Ellen Felicia Josh Juli Katherine Melody Michelle Neal Rachel Sheila Sheila Sherry Tiffany Wesley Question Title * 5. The Staff Excellent Good Fair Poor N/A Were professional Were professional Excellent Were professional Good Were professional Fair Were professional Poor Were professional N/A Were friendly Were friendly Excellent Were friendly Good Were friendly Fair Were friendly Poor Were friendly N/A Were skillful Were skillful Excellent Were skillful Good Were skillful Fair Were skillful Poor Were skillful N/A Made you feel comfortable Made you feel comfortable Excellent Made you feel comfortable Good Made you feel comfortable Fair Made you feel comfortable Poor Made you feel comfortable N/A Answered your questions Answered your questions Excellent Answered your questions Good Answered your questions Fair Answered your questions Poor Answered your questions N/A Kept you informed about your visit/progress Kept you informed about your visit/progress Excellent Kept you informed about your visit/progress Good Kept you informed about your visit/progress Fair Kept you informed about your visit/progress Poor Kept you informed about your visit/progress N/A Question Title * 6. Facility: Excellent Good Fair Poor Cleanliness Cleanliness Excellent Cleanliness Good Cleanliness Fair Cleanliness Poor Comfort Comfort Excellent Comfort Good Comfort Fair Comfort Poor Convenient Convenient Excellent Convenient Good Convenient Fair Convenient Poor Question Title * 7. Would you recommend Emergency Physicians Medical Center to your friends or family? Yes Maybe No Question Title * 8. How satisfied were you with your overall visit today? Very satisfied Somewhat satisfied It was OK Somewhat unsatisfied Very unsatisfied Question Title * 9. We respect your time. If you unfortunately had a longer than expected wait time: Excellent Good Fair Poor N/A Did you feel you were kept well informed? Did you feel you were kept well informed? Excellent Did you feel you were kept well informed? Good Did you feel you were kept well informed? Fair Did you feel you were kept well informed? Poor Did you feel you were kept well informed? N/A Did you feel you were kept as comfortable as possible during your stay? Did you feel you were kept as comfortable as possible during your stay? Excellent Did you feel you were kept as comfortable as possible during your stay? Good Did you feel you were kept as comfortable as possible during your stay? Fair Did you feel you were kept as comfortable as possible during your stay? Poor Did you feel you were kept as comfortable as possible during your stay? N/A Question Title * 10. Is there anything else you would like us to know about your visit today or how we can improve? Question Title Done
