Helotes Med Patient Satisfaction Survey

Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time. ( Please scroll down to submit survey).
Your Age*
Gender*

FemaleMaleRather not say
Your Race / Ethnicity*

AsianPacific IslanderBlack / African AmericanWhite Not Hispanic or LatinoHispanic or Latino All RacesUnknown
Ability to get in to be seen?*

GreatGoodOKFairPoor
Clinic Hours*

GreatGoodOKFairPoor
Clinic Hours*

GreatGoodOKFairPoor
Convenience of Clinic's Location*

GreatGoodOKFairPoor
Prompt Return on Calls*

GreatGoodOKFairPoor
Time in Waiting Room*

GreatGoodOKFairPoor
Time in Exam Room*

GreatGoodOKFairPoor
Waiting for Test Results*

GreatGoodOKFairPoor
How do you Feel Your PCP Listens to You?*

GreatGoodOKFairPoor
Do you Feel Your PCP Takes Enough Time With You?*

GreatGoodOKFairPoor

Does your doctor give you good advise and treatment? *

	1	2	3	4	5	6	7	8	9	10

1 is Poor, 10 is Great

Does your doctor explain what you want to know?*

	1	2	3	4	5	6	7	8	9	10

1 is Poor, 10 is Great

Is the staff friendly and helpful to you?*

	1	2	3	4	5

1 is Poor, 5 is Great

Do Staff members help answer questions you may have?*

	1	2	3	4	5

1 is Poor, 5 is Great

Explanation of Charges

	1	2	3	4	5

1 is Poor, 5 is Great

Collection of payment / Money

	1	2	3	4	5

1 is Poor, 5 is Great

Neatness and Cleanliness of Clinic*

	1	2	3	4	5

1 is Poor, 5 is Great

Ease of finding where to go*

	1	2	3	4	5

1 is Poor, 5 is Great

Comfort of Safety while waiting*

	1	2	3	4	5

1 is Poor, 5 is Great

How do we protect your privacy?*

	1	2	3	4	5

1 is Poor, 5 is Great

Do you consider us to be your regular source of care*

YesNo
What do you like best about our practice? *
What do you like least about our practice?*
Give us your suggestion for improvement*
Would you recommend our services with your circle of friends or relatives?*

YesNo
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