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OB Patient Satisfaction Survey
*
1.
Which provider did you see today?
(Required.)
Dr Ahadi
Dr Mossallam
Dr Khaghany
Dr Pakideh
Beth Junkin
Other (please specify)
2.
I am able to get through to the office on the phone during office hours
Always
Sometimes
Rarely
Never
3.
In the last 12 months, when you phoned your healthcare provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed?
Never
Sometimes
Usually
Always
N/A
4.
How convenient was the appointment time you were able to get?
Extremely convenient
Somewhat convenient
Not at all convenient
If not, what would make it more convenient?
5.
How easy is it to schedule urgent appointments with your provider when you're ill?
Extremely easy
Very easy
Moderately easy
Slightly easy
Not at all easy
N/A
6.
How courteous and helpful was the receptionist when you arrived at our office?
Extremely
Very
Somewhat
Not very
Not at all
7.
How friendly was the clinical staff during your visit?
Extremely friendly
Very friendly
Somewhat friendly
Not so friendly
Not at all friendly
8.
Overall, how often do you wait more than 15 minutes to see your provider? (Wait time includes time spent in the waiting room and exam room.)
Always
Most of the time
About half of the time
Once in a while
Never
9.
How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
10.
Were your needs met at this visit?
Extremely well
Very well
Somewhat well
Not so well
Not at all
11.
Did you observe the medical staff wash their hands or use hand sanitizer?
Yes
No
12.
Did anyone talk to you about the medication you take?
Yes
No
13.
Were you asked if you had visits with other health care providers since your last visit?
Yes
No
14.
Did anyone help you make an appointment with a specialty provider if necessary?
Yes
No
NA
15.
Have we ever given you information about FMC being your medical home?
Yes
No
16.
Have we ever helped you find other community resources you might need that FMC does not provide?
Yes
No
NA
17.
Do you feel what you pay for your care is reasonable?
Extremely reasonable
Very reasonable
Somewhat reasonable
Not very reasonable
Not at all reasonable
18.
May we contact you for further input regarding your thoughts on FMC?
Yes
No
If yes, please supply preferred contact information
19.
Would you recommend FMC to your friends and family?
Definitely no
Probably no
Probably yes
Definitely yes
20.
How did you hear about Family Medical Center?
Family/Friends
Direct mailing/Letter from FMC
Newspaper/Magazine Ad
Internet Search
Health Insurance
Health Department/WIC/Monroe County Community Mental Health
Hospital
School/Work
Community Event
Other (please specify)
21.
Do you have any comments or suggestions?
*
22.
Is this your first visit with Family Medical Center?
(Required.)
Yes
No