Patient Satisfaction Survey


Patient Satisfaction Survey

Our Physician

Your Appointment

1. The length of time between your call or email for an appointment and when scheduled to be seen.*
Answer is required

2. The waiting time in our reception area prior to being seen.*
waiting time in our reception area is required

3. The waiting time in the exam room prior to being seen by your doctor.*
Waiting time in the exam room is required

Our Facility

1. The convenience of our office hours and our location.*
Convenience of hours and our location is required

2. The cleanliness and comfort of the office.*
Cleanliness and comfort is required

3. Our parking spacer.*
Our parking spacer is required

Our Communication

1. Your ease in reaching our office by telephone or by email.*
Ease in reaching our office is required

2. The quality of information that we provide by phone or by email.*
Quality of information is required

3. Timely reporting of your test and procedures results.*
Test and procedures results is required

Our Staff

1. The courtesy of our receptionists.*
The courtesy of our receptionists is required

2. The courtesy of our assistants.*
The courtesy of our assistants is required

3. The courtesy of our business and insurance office personnel.*
The courtesy of our business and insurance office personnel is required

1. The attitude and conversation between our physician and you*
The attitude and conversation between our physician and you is required

2. Discussion of diagnosis and treatment options so that you understood your choices.*
Options so that you understood your choices is required

3. The overall satisfaction with your physician.*
Overall satisfaction with your physician is required

Overall Satisfaction

1. Your overall satisfaction with our practice.*
Overall satisfaction is required

2. Would you recommend this practice to a member of your family or a friend?*
Yes or No is required

Other comments

Please feel free to add comments.
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