Patient Satisfaction Survey

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    Patient Satisfaction Survey

    Welcome to your Patient Satisfaction Survey

    SOME INFORMATION ABOUT YOU:





    Name
    Your Email
    Health History
    Your ID
    What was the date of your most recent appointment?
    How did you find out about us?



     
    What location did you go?



     

    YOUR APPOINTMENT:




    Ease of making appointments by phone  

    Appointment available within a reasonable amount of time
    Getting care for illness/injury as soon as you wanted it

     

    Getting after-hours care when you needed it

     

    The efficiency of the check-in process

     

    Waiting time in the reception area

     

    Waiting time in the exam room

     

    Keeping you informed if your appointment time was delayed

     

    Ease of getting a referral when you needed one

     

    B.


    OUR STAFF:


    The courtesy of the person who took your call

    The friendliness and courtesy of the receptionist

     

    The caring concern of our nurses/medical assistants

     

    The helpfulness of the people who assisted you with 
    The professionalism of our lab or x-ray staff

     

    C.


    OUR COMMUNICATION WITH YOU:




    Your phone calls answered promptly

    Getting advice or help when needed during office hours
    Explanation of your procedure (if applicable)

     

    Your test results reported in a reasonable amount of time

     

    Effectiveness of our health information materials

     

    Our ability to return your calls in a timely manner

     

    Your ability to contact us after hours
    Your ability to obtain prescription refills by phone

     

    D.

    YOUR VISIT WITH THE PROVIDER: (Doctor, Physician Assistant, Nurse Practitioner).


    Willingness to listen carefully to you

    Taking time to answer your questions

     

    Amount of time spent with you

     

    Explaining the skin, hair or nail conditions  in a way you could understand

     

    Instructions regarding medication/follow-up care

     

    The thoroughness of the examination
    Advice given to you on ways to stay healthy
    E.

    OUR FACILITY:


    Hours of operation convenient for you



     

    F.

    YOUR OVERALL SATISFACTION WITH

    Our practice

    The quality of your medical care
    Your provider
    The staff nurse
    <h3><strong>SOME INFORMATION ABOUT YOU:</strong></h3><br /> <p><br />GENDER</p>
    WOULD YOU RECOMMEND US TO OTHERS?  PLEASE TELL US WHY:
    THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT
    Would you like to receive a call from us regarding your visit?

    SOME INFORMATION ABOUT YOU:



    GENDER
    YOUR AGE
    REASON FOR VISIT
    ONLINE OR IN-PERSON