Patient Satisfaction Survey

Question Title

* 1. What provider did you see today?

Karisa Young FNP-BC

Mike Wilt PA

Other (please specify)

Question Title

* 2. Was this your first visit to our office?

Yes

No

Question Title

* 3. How many minutes did you wait after you scheduled your appointment time before you were called to the exam room?

5-10 minutes

10-15 minutes

20-25 minutes

Longer

Question Title

* 4. How many minutes did you wait in the exam room before your provider arrived?

5-10 minutes

10-15 minutes

20-25 minutes

Longer

Question Title

* 5. If you waited longer than 15 minutes, did the staff keep you informed of wait status?

Yes

No

N/A