Patient Survey

Please take a moment to evaluate your experience at us so we may learn how to better serve you.

1. Overall, how satisfied are you with the provider you saw today? (required)
Extremely SatisfiedSatisfiedSomewhat SatisfiedNeither Satisfied nor DisatisfiedSomewhat DissatisfiedVery DissatisfiedCompletely Dissatisfied
2. Your ease of contacting us by phone was?
ExcellentVery GoodGoodFairPoor
3. Your ability to speak with the provider was?
ExcellentVery GoodGoodFairPoor
4. The amount of days you waited for your appointment was?
ExcellentVery GoodGoodFairPoor
5. The cleanliness and comfort of the office was?
ExcellentVery GoodGoodFairPoor
6. The office wait time to see the doctor was?
ExcellentVery GoodGoodFairPoor
7. The courtesy and helpfulness of the office receptionist was?
ExcellentVery GoodGoodFairPoor
8. The courtesy and helpfulness shown to you by the medical assistants?
ExcellentVery GoodGoodFairPoor
9. How well did the doctor explain what he/she was doing?
ExcellentVery GoodGoodFairPoor
10. How well did the doctor use words that were easy to understand?
ExcellentVery GoodGoodFairPoor
11. How well did the doctor listen to your concerns or questions?
ExcellentVery GoodGoodFairPoor
12. How well did the doctor answer your questions?
ExcellentVery GoodGoodFairPoor
13. How was the warmth and caring demonstrated to you by the doctor?
ExcellentVery GoodGoodFairPoor
14. How was the amount of time you had with the doctor during your visit?
ExcellentVery GoodGoodFairPoor
15. What impressed you the most about the doctor?

16. What could be improved?

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