Survey

Would you take a few minutes of your time to help us? Our goal is to provide comfort, convenience and satisfaction, as well as the best medical care to all our patients. We would like to know how you feel about our medical services, our patient-handling systems and our physiscians and staff members. Your comments will help us to evaluate our operations to ensure that we are truly responsive to your needs. Thank you for your help.

PLEASE SELECT YOUR MOST APPROPRIATE RESPONSE

HOW SATISFIED ARE YOU WITH:

N/ABadPoorGoodGreat
1. Your communication with our:
A. Front desk receptionist
B. Telephone receptionist
C. Billing department staff
D. Nurses
E. Medical Assistants
YOUR COMMENTS:
N/ABadPoorGoodGreat
2. The efficiency of our:
A. Front desk receptionist
B. Telephone receptionist
C. Billing department staff
D. Nurses
E. Medical Assistants
YOUR COMMENTS:
N/ABadPoorGoodGreat
3. How would you rate our nurses in terms of:
A. Responsiveness to your questions
B. Time spent with patients
C. Medical knowledge
YOUR COMMENTS:
N/ABadPoorGoodGreat
4. How would your appointments with us:
A. Available within a reasonable amount of time
B. Scheduled at a convenient time of day
C. Completed in a timely manner
D. Availability with provider desired
YOUR COMMENTS:
N/ABadPoorGoodGreat
5. During your appointment with our DOCTOR do you feel:
A. The doctor listened & your questions were answered
B. The examination was thorough
C. The amount of time spent with you was appropriate
Who was your appointment with?
N/ABadPoorGoodGreat
6. During your appointment with our NURSE PRACTITIONER (NP) do you feel:
A. The NP listened & your questions were answered
B. The examination was thorough
C. The amount of time spent with you was appropriate
Who was your appointment with?
YOUR COMMENTS:
OB care
GYN care
Well health
Surgery
Postpartum care
Other:
7. Was this appointment for:
N/ABadPoorGoodGreat
8. Please rate our communication with you in the following areas:
A. Were your calls answered promptly
B. Availability of medical information/advice by phone
C. The provider returning your call in a timely manner
D. Test results reported in a reasonable amount of time
E. Effectiveness of health information materials
YOUR COMMENTS:
Family Member
Friend
Co-worker
Yellow Pages Ad
Our website
9. How did you hear about us?
N/ABadPoorGoodGreat
10. How would you rate our facility:
A. Hours of operation were convenient
B. Overall comfort of office
C. Adequate parking
D. Signage and directions easy to follow
YOUR COMMENTS:
N/ABadPoorGoodGreat
11. Overall rating:
A. Our practice
B. Quality of your medical care
Yes
No
12. Would you recommend our office to a friend?
YOUR COMMENTS:
Evening
Morning
Both
Neither
13. If available to you, would you consider an evening appointment from 5:00 pm - 8:00 pm or an early morning appointment prior to 8:00 am?
Laser hair removal
Spider vein removal
Skin Care Products
Weight and diet control classes
Massage therapy
Patient Education Classes
Other:
14. Would you be interested in:
15. If you would like someone from our office to contact you, please provide your name and daytime phone number: