Patient Satisfaction Survey

1. How did you hear about our practice?
 




 
2. How were you greeted upon your initial contact with our office?
 


 
3. Ease of scheduling an appointment via phone?
 



 
4. Did you have any problems scheduling an appointment?
 
 
5. How would you rate the courtesy of the staff upon your arrival and during your wait?
 



 
6. How long did you wait in the reception area beyond your scheduled appointment time?
 


 
7. How long did you wait in the exam room before a clinical staff member appeared?
 


 
8. How would you rate the competence of the clinical staff that assisted you?
 



 
9. How would you rate the concern our clinical staff showed for your need of treatment?
 



 
10. Which Care provider examined you?
 



 
11. Did you feel a thorough examination was conducted by our health care provider?
 

 
12. Did the health care provider satisfactorily answer your questions?
 

 
13. Would you recommend our facility to your family and friends
 

 
14. Please share your zip code:
 
 
15. Please add any additional comments or suggestions: