Patient Satisfaction Survey

How satisfied are you with the following?

1. Ease of making appointment?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

2. Ease in contacting your doctor when our office is closed (nights and weekends)?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

3. Ease in speaking directly with your doctor by telephone when you call during office hours?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

4. The time it takes someone from our office to respond when you call the office with an urgent problem?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

5. Waiting time in our office?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

6. Ease in obtaining follow-up information and care (test results, medicines, care instructions)?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

7. Overall medical care at your doctor’s office?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

8. Our office’s appearance?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

9. Our office’s convenience (location, parking, hours, office layout)?
Extremely SatisfiedVery SatisfiedSatisfiedVery DissatisfiedExtremely Dissatisfied

How caring would you say the following individuals are?

10. Your doctor?
Extremely CaringVery CaringCaringVery UncaringExtremely Uncaring

11. Our medical staff?
Extremely CaringVery CaringCaringVery UncaringExtremely Uncaring

12. Our office staff?
Extremely CaringVery CaringCaringVery UncaringExtremely Uncaring

13. Would your recommend your doctor to your family or friends?
DefinitelyProbablyNot SureProbably NotDefinitely Not

Please leave this field empty.

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