Patient Satisfaction Survey

Please fill out the questions below. There is a drop down list with
a 1 to 5 rating system. The rating system is as follows.
(1) Very Dissatisfied, (2) Somewhat Dissatisfied , (3) Somewhat Satisfied ,
(4) Very Satisfied or (5) Completely Satisfied?

Encounter ID

1. What number would you use to rate all of your healthcare in the last 12 months?

2. What number would you use to rate your ability to obtain needed care right away?

3. What number would you use to rate your ease of getting an appointment with a specialist?

4. How would you rate the self management tools provided to you by your doctor’s office?

5. How would you rate the personal manner (courtesy, respect, communication skills, sensitivity, friendliness) of the doctor?

6. How would you rate the skills (thoughtfulness, carefulness, completeness, enough time spent) of the doctor?

7. How would you rate the communication skills of the staff?

8. How would you rate getting an appointment as soon as you wanted?

9. How would you rate the follow-up and coordination of your care by the physician/staff?

10. Considering all aspects of the medical office, would you say you are: completely satisfied, very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied?

Comments
300 characters remaining remaining

Patient Satisfaction Survey

Please fix these first