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PATIENT SATISFACTION SURVEY

Please rate the following areas of your experience:

           

Appointment Scheduling

Poor Average Great N/A
Was your call answered promptly?
Did the scheduler greet you in a friendly manner?
Was your appointment scheduled within a reasonable time frame?
           

Check-in

       
Did the receptionist greet you with a smile?
Were you kept informed of any delays?
           

Clinical Area

       
Did the medical assistant greet you warmly?
Did the medical assistant seem knowledgeable?
Were your questions answered adequately?
           

Quality of Care

       
Did your provider listen to your concern(s)?
Did your provider explain your diagnosis thoroughly?
Did your provider use language you could understand?
Did you feel your problem(s) were addressed adequately?
           

Wait Times

       
How long did you wait in the reception area? Minimal Acceptable Excessive  
How long did you wait in the exam room? Minimal Acceptable Excessive  
           
Would you recommend this practice to friends and family? Yes No    
Which provider did you see?
   

Additional Comments:

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