Patient Satisfaction Survey

We are constantly striving to provide better treatment and care for our patients. We would like to know how you perceive our services. Please take a few minutes to complete this Patient Survey Questionnaire. Your responses are anonymous and will be used to better the office. Your cooperation is greatly appreciated.

_2017 Survey

Please use the following scale for your responses:

5. Very Good 4. Good 3. Average 2. Poor 1. Very Poor

1. Please rate the appearance/impression of the following areas:

Waiting Room 5 4 3 2 1

Reception Desk 5 4 3 2 1

Treatment Area(s) 5 4 3 2 1

Consultation Room 5 4 3 2 1

2. Please rate the appearance and professionalisim of our front desk staff

5 4 3 2 1

3. Please rate your observations as it pertains to our front desk staff (specific staff names will be helpful)

4. Please rate the appearance and professionalism of our nursing/assisting staff

5 4 3 2 1

5. Please relate your observations as it pertains to our nursing/assisting staff (specific staff names will be helpful)

6. Please relate your observations as it pertains to our doctors/physicians

5 4 3 2 1

7. How satisfied are you with the availability of appointment times?

5 4 3 2 1

8. How do we rate with regards to keeping on time for your scheduled appointments?

5 4 3 2 1

9. If you needed an emergency appointment, how would you rate the response of the doctors and/or staff?

5 4 3 2 1 N/A

10. How would you rate the way in which your treatment was explained to you?

5 4 3 2 1

11. How satisfied are you with our financial policies and billing arrangements?

5 4 3 2 1

12. Based on your experience, how likely are you to recommend our office to your family or friends?

Would Recommend Unsure Would Not Recommend

13. Final Comments

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