Patient Satisfaction Survey

We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this survey. All responses are confidential, and we don’t want you to sign it or otherwise indicate your name. Just let us know what to do better!

Thank you.

On a scale from 1 to 5, with 5 being excellent and 1 being poor, how would you rate:

1. The time between your call to schedule an appointment and your appointment date? Did we fit you in fast enough?

2. The time it took us to answer your call?

3. The manners of the person(s) who scheduled your appointment?

4. The convenience of our location?

5. Parking convenience?

6. The professionalism and helpfulness of your reception. Was the receptionist polite? Were your questions answered?

7. Your wait time in the office?

8. The comfort, cleanliness and amenities of the reception?

The Doctor:

9. The amount of time spent with your physician?

10. His or her listening ?

11. His or her explanation of procedures, diagnoses, 
or treatment regimen?

12. His or her "bedside manner"?

13. If you have visited our practice before, how convenient did you find:
Prescription refills (if appropriate)?

14. Getting lab results (if appropriate)?

15. Overall, how would you rate our practice?

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