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Patient Satisfaction Survey

We are committed to ensuring that you are satisfied with the care and services you receive at our practice. Please let us know what you think about your experience with us.
Please rate your level of satisfaction for the following:
0 - NA | 1 - Strongly Disagree | 2 - Disagree | 3 - Neutral | 4 - Agree | 5 - Strongly Agree

1. Your Communication with our,

Space Cell	NA	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Telephone Receptionist	Telephone Receptionist: NA	Telephone Receptionist: Strongly Disagree	Telephone Receptionist: Disagree	Telephone Receptionist: Neutral	Telephone Receptionist: Agree	Telephone Receptionist: Strongly Agree
Triage Nurses	Triage Nurses: NA	Triage Nurses: Strongly Disagree	Triage Nurses: Disagree	Triage Nurses: Neutral	Triage Nurses: Agree	Triage Nurses: Strongly Agree
Front Desk Receptionists	Front Desk Receptionists: NA	Front Desk Receptionists: Strongly Disagree	Front Desk Receptionists: Disagree	Front Desk Receptionists: Neutral	Front Desk Receptionists: Agree	Front Desk Receptionists: Strongly Agree
Medical Assistants	Medical Assistants: NA	Medical Assistants: Strongly Disagree	Medical Assistants: Disagree	Medical Assistants: Neutral	Medical Assistants: Agree	Medical Assistants: Strongly Agree
Medical Records Staff	Medical Records Staff: NA	Medical Records Staff: Strongly Disagree	Medical Records Staff: Disagree	Medical Records Staff: Neutral	Medical Records Staff: Agree	Medical Records Staff: Strongly Agree
Ultrasound Tech	Ultrasound Tech: NA	Ultrasound Tech: Strongly Disagree	Ultrasound Tech: Disagree	Ultrasound Tech: Neutral	Ultrasound Tech: Agree	Ultrasound Tech: Strongly Agree
Surgical Scheduling	Surgical Scheduling: NA	Surgical Scheduling: Strongly Disagree	Surgical Scheduling: Disagree	Surgical Scheduling: Neutral	Surgical Scheduling: Agree	Surgical Scheduling: Strongly Agree
Billing department Staff	Billing department Staff: NA	Billing department Staff: Strongly Disagree	Billing department Staff: Disagree	Billing department Staff: Neutral	Billing department Staff: Agree	Billing department Staff: Strongly Agree

2. The Efficiency of our,

Space Cell	NA	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Telephone Receptionist	Telephone Receptionist: NA	Telephone Receptionist: Strongly Disagree	Telephone Receptionist: Disagree	Telephone Receptionist: Neutral	Telephone Receptionist: Agree	Telephone Receptionist: Strongly Agree
Triage Nurses	Triage Nurses: NA	Triage Nurses: Strongly Disagree	Triage Nurses: Disagree	Triage Nurses: Neutral	Triage Nurses: Agree	Triage Nurses: Strongly Agree
Front Desk Receptionists	Front Desk Receptionists: NA	Front Desk Receptionists: Strongly Disagree	Front Desk Receptionists: Disagree	Front Desk Receptionists: Neutral	Front Desk Receptionists: Agree	Front Desk Receptionists: Strongly Agree
Medical Assistants	Medical Assistants: NA	Medical Assistants: Strongly Disagree	Medical Assistants: Disagree	Medical Assistants: Neutral	Medical Assistants: Agree	Medical Assistants: Strongly Agree
Medical Records Staff	Medical Records Staff: NA	Medical Records Staff: Strongly Disagree	Medical Records Staff: Disagree	Medical Records Staff: Neutral	Medical Records Staff: Agree	Medical Records Staff: Strongly Agree
Ultrasound Tech	Ultrasound Tech: NA	Ultrasound Tech: Strongly Disagree	Ultrasound Tech: Disagree	Ultrasound Tech: Neutral	Ultrasound Tech: Agree	Ultrasound Tech: Strongly Agree
Surgical Scheduling	Surgical Scheduling: NA	Surgical Scheduling: Strongly Disagree	Surgical Scheduling: Disagree	Surgical Scheduling: Neutral	Surgical Scheduling: Agree	Surgical Scheduling: Strongly Agree
Billing Department Staff	Billing Department Staff: NA	Billing Department Staff: Strongly Disagree	Billing Department Staff: Disagree	Billing Department Staff: Neutral	Billing Department Staff: Agree	Billing Department Staff: Strongly Agree

3. How would you rate your appointments with us:

Space Cell	NA	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Completed in a timely manner	Completed in a timely manner: NA	Completed in a timely manner: Strongly Disagree	Completed in a timely manner: Disagree	Completed in a timely manner: Neutral	Completed in a timely manner: Agree	Completed in a timely manner: Strongly Agree
Availability with desired provider	Availability with desired provider: NA	Availability with desired provider: Strongly Disagree	Availability with desired provider: Disagree	Availability with desired provider: Neutral	Availability with desired provider: Agree	Availability with desired provider: Strongly Agree

4. During your appointment with our provider, do you feel:

Space Cell	NA	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The provider listened & your questions were answered	The provider listened & your questions were answered: NA	The provider listened & your questions were answered: Strongly Disagree	The provider listened & your questions were answered: Disagree	The provider listened & your questions were answered: Neutral	The provider listened & your questions were answered: Agree	The provider listened & your questions were answered: Strongly Agree
The examination was thorough	The examination was thorough: NA	The examination was thorough: Strongly Disagree	The examination was thorough: Disagree	The examination was thorough: Neutral	The examination was thorough: Agree	The examination was thorough: Strongly Agree
The amount of time spent with you was appropriate	The amount of time spent with you was appropriate: NA	The amount of time spent with you was appropriate: Strongly Disagree	The amount of time spent with you was appropriate: Disagree	The amount of time spent with you was appropriate: Neutral	The amount of time spent with you was appropriate: Agree	The amount of time spent with you was appropriate: Strongly Agree

6. Please rate our communication with you in the following areas:

Space Cell	NA	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Were your calls answered promptly	Were your calls answered promptly: NA	Were your calls answered promptly: Strongly Disagree	Were your calls answered promptly: Disagree	Were your calls answered promptly: Neutral	Were your calls answered promptly: Agree	Were your calls answered promptly: Strongly Agree
Availability of medical information/advice by phone	Availability of medical information/advice by phone: NA	Availability of medical information/advice by phone: Strongly Disagree	Availability of medical information/advice by phone: Disagree	Availability of medical information/advice by phone: Neutral	Availability of medical information/advice by phone: Agree	Availability of medical information/advice by phone: Strongly Agree
The provider returning your call in a timely manner	The provider returning your call in a timely manner: NA	The provider returning your call in a timely manner: Strongly Disagree	The provider returning your call in a timely manner: Disagree	The provider returning your call in a timely manner: Neutral	The provider returning your call in a timely manner: Agree	The provider returning your call in a timely manner: Strongly Agree
Test results reported in a reasonable amount of time	Test results reported in a reasonable amount of time: NA	Test results reported in a reasonable amount of time: Strongly Disagree	Test results reported in a reasonable amount of time: Disagree	Test results reported in a reasonable amount of time: Neutral	Test results reported in a reasonable amount of time: Agree	Test results reported in a reasonable amount of time: Strongly Agree
Effectiveness of health information materials	Effectiveness of health information materials: NA	Effectiveness of health information materials: Strongly Disagree	Effectiveness of health information materials: Disagree	Effectiveness of health information materials: Neutral	Effectiveness of health information materials: Agree	Effectiveness of health information materials: Strongly Agree

7. Overall rating of our practice:

Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied

8. Quality of your medical care:

Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied

9. Would you recommend our practice to a friend:

This is an anonymous survey, unless you type in your name.
If you have questions, or concerns that you would like addressed,
please feel free to type your full name and phone number in the comment box below.

10. General Comments

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