Friday, September 10, 2010



Patient Survey

Dear Patient:

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 very best medical care to all our patients. We'd like to know how you feel about our medical services, our patient-handling systems, our physicians, and our staff members. Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs.

It would be very helpful if you would provide your name, telephone number, and email address when responding to this survey. We take each survey response very seriously and would like to give you prompt feedback. We can only do that if you provide this information.

Thank you for your help!

HOW SATISFIED ARE YOU WITH:
YOUR APPOINTMENT:
1. Appointment available within a reasonable amount of time.



2. Appointment scheduled at a convenient time of day.



3. Waiting time in the reception area.



4. Waiting time in the exam room.





OUR STAFF:
5. The friendliness and courtesy of our receptionists.



6. The caring concern of our nurses.



7. The helpfulness of the people in our business office.



8. The professionalism of our technical staff.





OUR COMMUNICATION WITH YOU:
9. Your phone calls answered promptly.



10. Availability of medical information/advice by telephone.



11. Explanation of your test procedure (if applicable).



12. Your test results reported in a reasonable amount of time.



13. Effectiveness of our health information materials.



14. The doctor returning your calls in a timely manner.





YOUR VISIT WITH THE DOCTOR:
15. The doctor listening to you.



16. The doctor taking time to answer your questions.



17. The doctor adequately explaining treatment options.



18. The thoroughness of the examination.



19. Amount of time the doctor spent with you.



20. The outcome of treatment prescribed by your doctor.





OUR FACILITY:
21. Hours of operation convenient for you.



22. Overall comfort.



23. Adequate parking.



24. Signage and directions easy to follow.





OVERALL RATING:
Our Practice


The Quality of Your Medical Care


Would you recommend our practice to a family member or friend?


If there is any way we can improve our services to you, please tell us about it:
Your Name (Please Give Complete Name):
 Your Phone:
Your Email Address:
 Your Doctor (Required):