Patient Satisfaction Survey

Dear Patient: We are committed to provide quality service. The purpose of this survey is to find out how you feel about your healthcare, and to obtain ideas of how we can improve to best meet your needs. This is strictly confidential. Please feel free to be open and honest with your answers. THINKING ABOUT YOUR HEALTH CARE FROM YOUR ORTHOPAEDIC PHYSICIAN, PLEASE RATE THE FOLLOWING: (please mark one answer for each question)


Name (Optional):
Email (Optional):
Phone Number (Optional):

1. The ability to get through, by phone, to the person or department you want to reach:

2. The ability of the phone operator to direct your call correctly and efficiently:

3. The ability to arrange an appointment at a convenient time:

4. Convenience (close, easy to find) of the office location:

5. Our office hours:

6. Availability of parking at our office:

7. The length of time you waited between making an appointment for routine care and the day of the visit:

8. Waiting time in reception area if you had a scheduled appointment:

9. The friendliness, concern and courtesy shown to you by your Physician/PA:

10. The amount of time spent with the Physician/PA during a visit:

11. The thoroughness of the examination and treatment:

12. Explanation of your condition and treatment options:

13. Friendliness and courtesy shown by our staff:

14. Efficiency of the check-out process:

15. The helpfulness of our business staff in answering insurance and financial questions:

16. The comfort, appearance and cleanliness of our facilitites:

17. The accuracy and clarity of billing statements:

18. The appropriateness of the fee for the value of services you received:

19. How satisfied are you with the overall quality of care and services you received from your physician?

20. Would you recommend us to a friend?

If you could improve one thing about your time with us, what would that be? (Please include your response in this comment box)



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