Fill out a Patient Feedback Survey

Patient Feedback Survey

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Step 1

Patient Satisfaction Survey

Our office strives for excellence and wishes to provide you and your family the best all-around experience possible. Thank you for taking the time to complete our Patient Satisfaction Survey so that we can better care for you and your family.

Apointment Scheduling

	Yes	No
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

	Yes	No
Did the receptionist greet you with a smile?
Were you kept informed of any delays?

Clinical Area

	Yes	No
Did the medical assistant greet you warmly?
Did the medical assistant seem knowledgeable?
Were your questions answered adequately?

Quality of Care

	Yes	Somewhat	No
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

	Minimal	Acceptable	Excessive
How long did you wait in the reception area?
How long did you wait in the exam room?

Overall Experience

	Yes	No
Would you recommend this practice to friends and family?

Which Provider did you see?

Chris Burling, MDBeverley J. Springstead, MPAS, PA-C

Additional Comments or Suggestions:

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