Patient Satisfaction Survey
:: Outpatient Office ::

We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this confidential survey. Just let us know what we are doing well and what we can to do better!

Thank you


1
Please indicate your level of satisfaction with the following items related to your office appointment. Use a scale from strongly agree to strongly disagree. *
Please indicate your level of satisfaction with the following items related to your office appointment. Use a scale from strongly agree to strongly disagree.
Getting through to the office by phone
The time between your call to schedule an appointment and your appointment date
The manners of the person(s) who scheduled your appointment
Clarity of directions to the office and the time of your appointment
The professionalism and helpfulness of your reception
Your wait time in the office
The comfort, cleanliness and amenities of the reception area
The extent to which staff respected your privacy
2
Please rate the following items related to the delivery of your care. Use a scale from strongly agree to strongly disagree. *
Please rate the following items related to the delivery of your care. Use a scale from strongly agree to strongly disagree.
You physician/provider’s listening skills
His or her explanation of procedures, diagnoses or treatment regimen
His/her personal manner (courtesy, respect, sensitivity, friendliness)
Other staff’s personal manner (courtesy, respect, sensitivity, friendliness)
Technical skills (thoroughness, carefulness, competence) of the physician/practitioner
How prepared (records and educational materials readily available) the staff and physician/provider were for your visit
3
Please indicate the extent to which you agree or disagree with each of the following statements. Use a scale from strongly agree to strongly disagree. *
Please indicate the extent to which you agree or disagree with each of the following statements. Use a scale from strongly agree to strongly disagree.
My physician/provider spent adequate time with me
The service/care provided was valuable to improving my health
The educational information I received was helpful
I clearly understand the next steps in my plan of care
4
If lab work was done, did you receive your lab results in a timely manner following your office visit? *
5
Would you return to see this physician/practitioner for further care? *
6
Would you recommend this practice to family and friends? *
7
Did any specific staff member stand out? *
8
Was there any aspect of your care that could be improved? *
9