LAT Patient Satisfaction Survey

Your Physician may use a 3rd party to collate and report data from your responses. Thank you for your participation.
We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.

	Poor-1	Fair-2	Ok-3	Good-4	Great-5
A. The ease of obtaining an appointment	A. The ease of obtaining an appointment Poor-1	A. The ease of obtaining an appointment Fair-2	A. The ease of obtaining an appointment Ok-3	A. The ease of obtaining an appointment Good-4	A. The ease of obtaining an appointment Great-5
B. Overall length of time you spent waiting in the office	B. Overall length of time you spent waiting in the office Poor-1	B. Overall length of time you spent waiting in the office Fair-2	B. Overall length of time you spent waiting in the office Ok-3	B. Overall length of time you spent waiting in the office Good-4	B. Overall length of time you spent waiting in the office Great-5
C. Doctor, physician assistant, or nurse practitioner takes enough time with you	C. Doctor, physician assistant, or nurse practitioner takes enough time with you Poor-1	C. Doctor, physician assistant, or nurse practitioner takes enough time with you Fair-2	C. Doctor, physician assistant, or nurse practitioner takes enough time with you Ok-3	C. Doctor, physician assistant, or nurse practitioner takes enough time with you Good-4	C. Doctor, physician assistant, or nurse practitioner takes enough time with you Great-5
D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness	D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Poor-1	D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Fair-2	D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Ok-3	D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Good-4	D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Great-5
E. Nurse or medical assistants are friendly and helpful to you	E. Nurse or medical assistants are friendly and helpful to you Poor-1	E. Nurse or medical assistants are friendly and helpful to you Fair-2	E. Nurse or medical assistants are friendly and helpful to you Ok-3	E. Nurse or medical assistants are friendly and helpful to you Good-4	E. Nurse or medical assistants are friendly and helpful to you Great-5
F. Office reception and other staff are friendly and helpful to you	F. Office reception and other staff are friendly and helpful to you Poor-1	F. Office reception and other staff are friendly and helpful to you Fair-2	F. Office reception and other staff are friendly and helpful to you Ok-3	F. Office reception and other staff are friendly and helpful to you Good-4	F. Office reception and other staff are friendly and helpful to you Great-5
G. Your overall satisfaction with the quality of your medical care	G. Your overall satisfaction with the quality of your medical care Poor-1	G. Your overall satisfaction with the quality of your medical care Fair-2	G. Your overall satisfaction with the quality of your medical care Ok-3	G. Your overall satisfaction with the quality of your medical care Good-4	G. Your overall satisfaction with the quality of your medical care Great-5
H. The doctor or staff asked if I was experiencing any pain	H. The doctor or staff asked if I was experiencing any pain Poor-1	H. The doctor or staff asked if I was experiencing any pain Fair-2	H. The doctor or staff asked if I was experiencing any pain Ok-3	H. The doctor or staff asked if I was experiencing any pain Good-4	H. The doctor or staff asked if I was experiencing any pain Great-5
I. I am satisfied with the way my pain is currently being treated	I. I am satisfied with the way my pain is currently being treated Poor-1	I. I am satisfied with the way my pain is currently being treated Fair-2	I. I am satisfied with the way my pain is currently being treated Ok-3	I. I am satisfied with the way my pain is currently being treated Good-4	I. I am satisfied with the way my pain is currently being treated Great-5

Poor-1

Fair-2

Ok-3

Good-4

Great-5

A. The ease of obtaining an appointment

A. The ease of obtaining an appointment Poor-1

A. The ease of obtaining an appointment Fair-2

A. The ease of obtaining an appointment Ok-3

A. The ease of obtaining an appointment Good-4

A. The ease of obtaining an appointment Great-5

B. Overall length of time you spent waiting in the office

B. Overall length of time you spent waiting in the office Poor-1

B. Overall length of time you spent waiting in the office Fair-2

B. Overall length of time you spent waiting in the office Ok-3

B. Overall length of time you spent waiting in the office Good-4

B. Overall length of time you spent waiting in the office Great-5

C. Doctor, physician assistant, or nurse practitioner takes enough time with you

C. Doctor, physician assistant, or nurse practitioner takes enough time with you Poor-1

C. Doctor, physician assistant, or nurse practitioner takes enough time with you Fair-2

C. Doctor, physician assistant, or nurse practitioner takes enough time with you Ok-3

C. Doctor, physician assistant, or nurse practitioner takes enough time with you Good-4

C. Doctor, physician assistant, or nurse practitioner takes enough time with you Great-5

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Poor-1

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Fair-2

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Ok-3

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Good-4

D. Doctor, physician assistant, or nurse practitioner treated you with courtesy respect, sensitivity, and friendliness Great-5

E. Nurse or medical assistants are friendly and helpful to you

E. Nurse or medical assistants are friendly and helpful to you Poor-1

E. Nurse or medical assistants are friendly and helpful to you Fair-2

E. Nurse or medical assistants are friendly and helpful to you Ok-3

E. Nurse or medical assistants are friendly and helpful to you Good-4

E. Nurse or medical assistants are friendly and helpful to you Great-5

F. Office reception and other staff are friendly and helpful to you

F. Office reception and other staff are friendly and helpful to you Poor-1

F. Office reception and other staff are friendly and helpful to you Fair-2

F. Office reception and other staff are friendly and helpful to you Ok-3

F. Office reception and other staff are friendly and helpful to you Good-4

F. Office reception and other staff are friendly and helpful to you Great-5

G. Your overall satisfaction with the quality of your medical care

G. Your overall satisfaction with the quality of your medical care Poor-1

G. Your overall satisfaction with the quality of your medical care Fair-2

G. Your overall satisfaction with the quality of your medical care Ok-3

G. Your overall satisfaction with the quality of your medical care Good-4

G. Your overall satisfaction with the quality of your medical care Great-5

H. The doctor or staff asked if I was experiencing any pain

H. The doctor or staff asked if I was experiencing any pain Poor-1

H. The doctor or staff asked if I was experiencing any pain Fair-2

H. The doctor or staff asked if I was experiencing any pain Ok-3

H. The doctor or staff asked if I was experiencing any pain Good-4

H. The doctor or staff asked if I was experiencing any pain Great-5

I. I am satisfied with the way my pain is currently being treated

I. I am satisfied with the way my pain is currently being treated Poor-1

I. I am satisfied with the way my pain is currently being treated Fair-2

I. I am satisfied with the way my pain is currently being treated Ok-3

I. I am satisfied with the way my pain is currently being treated Good-4

I. I am satisfied with the way my pain is currently being treated Great-5

LAT Patient Satisfaction Survey_LAT

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* Please mark how well you think we are doing in the following areas during your most recent visit: Choose only one response per statement & respond to every statement.

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* J. I am currently experiencing some pain

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* Age:

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* Gender

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* Race

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* Selects the location for this visit:

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* Select the Healthcare Provider for this visit:

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* Day of the week of your visit:

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* Time of the day of your visit:

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* Comments: