Patient Satisfaction Survey

Patient Satisfaction Survey

This survey is designed to get feedback from patients bout their visits.

1.) How would you rate the person who scheduled your appointment?


Poor   Acceptable   Good   Excellent  

2.) Was the scheduler accommodating and informative?


Yes   No  

3.) Upon your arrival, how would you rate the receptionist who registered you?


Poor   Acceptable   Good   Excellent  

4.) Was the reception area clean and inviting?


No   Yes  

5.) How would you rate the medical assistant who provided your care (the person who took vital signs, EKG, blood work, ect.?


Poor   Acceptable   Good   Excellent  

6.) Was the exam room clean and comfortable?


No   Yes  

7.) How would you rate your medical examination with the Nurse Practitioner or Physician Assistant who provided your care?


Poor   Acceptable   Good   Excellent  

8.) Our continuing goal is provide an atmosphear of compassion, devotion, and respect to all who walk through our doors. Overall, how would you rate the level of care and attention that was provided to you?


Poor   Acceptable   Good   Excellent  


We listen with our hearts!