Satisfaction Survey

Download our Satisfaction Survery below.

Satisfaction Survey (PDF)

Patient Satisfaction Questionnaire

1. Ease of scheduling your appointment/procedure with your preferred physician

Poor

Fair

Good

Very Good

Excellent

N/A

2. Did the physician

listen closely to your concerns and respect on what you have to say?

Poor

Fair

Good

Very Good

Excellent

N/A

explain things in a way that was easy to understand?

Poor

Fair

Good

Very Good

Excellent

N/A

give you easy to understand information about your procedure, care and tests?

Poor

Fair

Good

Very Good

Excellent

N/A

spend enough time with you?

Poor

Fair

Good

Very Good

Excellent

N/A

3. Did our staff

make you feel welcome?

Poor

Fair

Good

Very Good

Excellent

N/A

return your phone calls or emails promptly?

Poor

Fair

Good

Very Good

Excellent

N/A

4. Did you receive a reminder for your appointment?

Yes

No

5. Did you use our Patient Portal?

Yes

No

6. Was the Patient Portal:

user friendly and easy to use?

Poor

Fair

Good

Very Good

Excellent

N/A

giving you the information that you needed?

Poor

Fair

Good

Very Good

Excellent

N/A

assisting on making/editing/cancelling your appointment?

Poor

Fair

Good

Very Good

Excellent

N/A

7. Did you visit our website?

Yes

No

8. How would you rate your overall experience with our website

Poor

Fair

Good

Very Good

Excellent

N/A

9. Please rate the following attributes of our website

Accuracy of information

Poor

Fair

Good

Very Good

Excellent

N/A

Ease of navigation

Poor

Fair

Good

Very Good

Excellent

N/A

Meeting your needs

Poor

Fair

Good

Very Good

Excellent

N/A

Quality of content

Poor

Fair

Good

Very Good

Excellent

N/A

Layout and design

Poor

Fair

Good

Very Good

Excellent

N/A

10. Do you have any other comments, questions, or concerns?

Submit