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Patient Satisfaction Survey

Below are a number of questions about your most recent physician office visit. Please answer each question by marking the box that best indicates your opinion, or, if a question does not apply to your situation, please mark "Does Not Apply". Your answers will help us to improve our service to you.

Date of your visit:

Before your Visit
How did you hear about our practice:
How would you rate the...ExcellentVery GoodGoodFairPoorDoes Not Apply
Ease in getting through to the doctor's office by phone?
Courtesy of the staff handling your call?
Availability of medical staff to speak on the phone during office hours?
Time between making an appointment and the day of your visit?
Ease in seeing the doctor of your choice?
Convenience of the location of the doctor's office?


At the time of your Visit
How would you rate the...ExcellentVery GoodGoodFairPoorDoes Not Apply
Courtesty of the receptionist?
Registration process?
(simplicity, speed, etc)
Comfort of the waiting area?
Waiting time to see the doctor?
How long did you wait?
Doctor overall?
Overall quality of care you received?
Amount of time spent with the doctor?
Doctor's explanation of what was done for you?
Doctor's personal manner?
(courtesty, sensitivity)
Doctor's instructions regarding medications & follow-up care?
Medical assistant overall?
Medical assistant's personal manner?
Cleanliness of the exam rooms & bathrooms?
Respect shown for your privacy?
Ease of arranging follow-up visits?


After your Visit
How would you rate the...ExcellentVery GoodGoodFairPoorDoes Not Apply
Outcome of your medical care?
(That is, given your problem, were you helped as much as expected?)
Promptness in obtaining test results
Manner in which your bill was handled by the cashier?
Accuracy of your bill (if you received one)?
Explanation of billing questions when you called?
Likelihood that you would recommend this practice?


If you have seen our physicians before, has the quality of our care:
Which doctor did you see?
Any additional comments and/or suggestions to improve our service are greatly appreciated.


 
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