Patient Satisfaction

1. Patient Satisfaction Survey - NEW

 
We care about you. YOUR FEEDBACK IS VERY IMPORTANT TO US! IF FOR SOME REASON YOU THINK WE ARE NOT AT 5 STAR, IT IS A FAILURE ON OUR PART. To get an honest opinion from you, this survey is anonymous and can not be tracked to you, unless you choose. But we very much appreciate if you are available to talk to us about your experience.
1. How easy was it to schedule this appointment?
***************
Rating (5 is best)
2. When was your appointment?
MM DD YYYY
Date
/
/
*
3. Which location did you visit?
*
4. Which of our physicians did you see at your visit?
5. During your visit, the RECEPTION (front office) staff was helpful & courteous.
***************
Rating (5 is the best)
6. The NURSES/ MEDICAL ASSISTANT staff was courteous, helpful and easy to understand:
***************
Your rating (5 is the best)
7. If the staff behavior was not good, or downright bad, please help us improve on it. What did you not like?
8. Waiting time (from your appointment time) BEFORE YOU SAW THE DOCTOR.
9. Did the doctor LISTEN to you and ANSWER the questions?
10. Amount of time THE DOCTOR SPENT WITH YOU.
11. During your visit the doctor’s instructions were EASY TO UNDERSTAND.
12. At the end of the visit, the DISCHARGE instructions were easy to understand.
***************
Your rating (***** is the best)
*
13. I would recommend this practice to my family & friends.
14. Can we contact you? If so, please fill the information. ZIP code is required.
Powered by SurveyMonkey
Check out our sample surveys and create your own now!