Questions
Rate your satisfaction with the following:
1.
Please rate your satisfaction with the promptness with which your calls were answered.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
2.
Please rate your satisfaction with the courtesy of the staff over the telephone.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
3.
Please rate your satisfaction with the ease of making appointments for checkups.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
4.
Please rate your satisfaction with the ease with which you were able to make appointments for problems.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
5.
Please rate your satisfaction with the amount of time your physician spent with you.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
6.
Please rate your satisfaction with the courtesy of the staff when you arrived for your appointments.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
7.
Please rate your satisfaction with the general appearance of the office.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
8.
Please rate your satisfaction with the courtesy of the medical assistants during your visit.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
9.
Please rate your satisfaction with the overall quality of your care.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
10.
Please rate your satisfaction with the availability of a physician after regular office hours.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
11.
Please rate your satisfaction with the personal concern shown to you by your physician.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
12.
Please rate your satisfaction with explanations of tests or procedures performed.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
13.
Please rate your satisfaction with the instructions for taking medications.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
14.
Please rate your satisfaction with your opportunity to ask questions.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
15.
Please rate your satisfaction with the answers to your questions.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
16.
Please rate your satisfaction with the explanation of payment.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
17.
Please rate your satisfaction with the results of your care.
--Please Choose--
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Not Applicable
18.
Additional comments are welcomed.