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Patient Satisfaction Survey
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Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.

Thank you for your time.


Questions prefixed with an * are required
*1. Age
*2. Gender
*3. Race / Ethnicity
*4. Ease of getting care
ExcellentGoodFairPoorN/A
Ability to get in to be seen
Hours Center is open
Convenience of Center's location
Prompt return on calls
*5. Waiting
ExcellentGoodFairPoorN/A
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results
*6. Which doctor did you see?
*7. Provider: (Physician, Dentist, Physician Assistant, Nurse Practitioner)
ExcellentGoodFairPoorN/A
Listens to you
Takes enough time with you
Explains what you want to know
Gives you good advice and treatment
Nurses and Medical Assistants
Friendly and helpful to you
Answers your questions
*8. All other staff
ExcellentGoodFairPoorN/A
Friendly and helpful to you
Answers your questions
*9. Charges / Billing
ExcellentGoodFairPoorN/A
Cost of services
Explanation of charges
Collection of payment/money
*10. Facility
ExcellentGoodFairPoorN/A
Neat and clean building
Ease of finding where to go
Comfort and Safety while waiting
Privacy
*11. Would you refer us to your friends or relatives
12. What do you like best about our center
13. What do you like least about our Center
14. Suggestions for improvement

   

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