The New England Wellness Group Patient Visit Experience Survey

The New England Wellness Group Patient Visit Experience Survey

Please share your feedback about your recent visit to help us improve.
Full Name

First NameLast Name
Your Provider
1. Who was your provider during your visit today?
2. Is this the provider you usually see if you need a check-up, advice about a health problem, or care when you are sick or injured?
3. How long has it been since your most recent visit with this provider?
4. What type of visit was your most recent appointment?
5. If your visit was virtual (phone or video), how easy was the technology to use?
6. Did your appointment with your provider start early, late, or on time?
7. Was your most recent visit for a health concern that needed care right away?
8. How well did your provider listen to your needs or concerns?
9. How well did your provider explain your condition or treatment options?
10. Did your provider show respect for what you had to say?
11. Did your provider spend enough time with you during your visit?
12. If follow-up care or tests were recommended, how well were the next steps explained to you?
13. How would you rate the service you received from the reception or front desk staff?
14. How satisfied are you with the cleanliness and appearance of our facility?
15. Overall, how satisfied were you with your most recent visit?
16. Using a scale from 0–10, how likely are you to recommend this provider to a friend or family member?

0

1

2

3

4

5

6

7

8

9

10

0 is , 10 is
Have you used same-day appointments in the past?
Our practice offers same-day appointments in the morning and afternoon each day. What times would you prefer?
Section 7 — Additional Feedback
Is there anything we could have done to improve your visit?
Should be Empty: