Patient Satisfaction Survey Question Title * 1. What provider were you seen by at your most recent visit? Michael J. Bradley D.O. Joseph F. Rubacky D.O. FAAFP Sharad C. Patel M.D. Shalini B. Shah M.D. Tatsiana Peters M.D. James Fletcher D.O. Neil L. Whaley III, PA-C Michelle Finnegan PA-C Question Title * 2. If you are a new patient, how did you hear about our practice? Friend/Relative Newspaper/Internet 55+ Expo Question Title * 3. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 4. What is your ethnicity? (Please select all that apply.) American Indian or Alaskan Native Asian or Pacific Islander Black or African American Hispanic or Latino White / Caucasian Prefer not to answer Other (please specify) Question Title * 5. In the last 12 months, has a lack of money kept you from going to the doctor, or not? Yes, it has No, it has not Question Title * 6. During your most recent visit, did your healthcare provider listen carefully to you? Yes, definitely Yes, somewhat No Question Title * 7. During your most recent visit, did your healthcare provider explain things in a way that was easy to understand? Yes, definitely Yes, somewhat No Question Title * 8. How easy is it to schedule urgent appointments with your doctor when you're ill? Extremely easy Very easy Moderately easy Slightly easy Not at all easy N/A Question Title * 9. How easy or difficult was it to schedule your appointment at a time that was convenient for you? Very easy Somewhat easy Neither easy nor difficult Somewhat difficult Very difficult N/A Question Title * 10. 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 Question Title * 11. During your most recent visit, did your healthcare provider give you easy to understand information about these health questions or concerns? Yes, definitely Yes, somewhat No Question Title * 12. 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 Question Title * 13. If you had to spend more than 15 minutes in the waiting room before you saw someone for your appointment, how often did someone tell you why there was a delay or how long the delay would be? Never Sometimes Usually Always N/A Question Title * 14. During your most recent visit, did your healthcare provider order a blood test, x-ray, or other test for you? Yes No Question Title * 15. At your appointment did the Medical Assistant that took you back introduce themselves to you? Yes No N/A Question Title * 16. At the end of your visit (usually at checkout) were you offered a copy of your office visit ? For Follow my Health account patients was a copy sent to your account ? yes no Question Title * 17. Have you had a visit to the Emergency Department or Walk-in in the past six months? If yes, please give a brief description of the reason why. Yes No If you answered yes, please leave description of why here. Question Title * 18. At Dover Family Physicians we value the opinion of our patients. Please take a moment to express any comments or suggestions you may have. Done
