Patient Satisfaction Survey

Patient Satisfaction Survey

We value the opinions of our patients and their families. Please take a few moments to complete this survey.
1. Scheduling appointments is easy and I am able to schedule for a time that is convenient for me*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
2. Wait times after checking in are reasonable and I am informed of any delays*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
3. Front desk staff is courteous and helpful*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
4. Medical Assistants are patient*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
5. Medical Assistants are knowledgeable*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
6. Doctors are kind*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
7. Doctors are knowledgeable*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
8. Staff spends enough time with me during my visit*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
9. All my concerns were addressed during my visit*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
10. I was given clear instructions on what to do about my condition or health*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
11. My privacy was respected*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
12. My billing or claim concerns were handled in a courteous and helpful manner*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
13. Office is clean and well-maintained*

Strongly AgreeAgreeNeutral / No OpinionDisagreeStrongly Disagree
14. Would you recommend our practice to a family member or friend?*

YesNoMaybe
15. Overall how would you rate us?*
Are there other suggestions or concerns you would like to share with us?
Do you have a positive experience you would like to share with us?
Would you like to be contacted by someone in our office?*

YesNo
If you wish to remain anonymous, it is not required to provide your information.
Name

PrefixFirst NameLast Name
Phone Number

Area CodePhone Number
E-Mail
example@example.com
Please verify that you are human*
Should be Empty: