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Patient Satisfaction

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We want to give you the best possible medical care. To do that, we need your feedback. Please let us know what you think we are doing right and how we can improve by filling out the following survey. All of your responses will be kept strictly confidential, and your signature is not required. Please use this opportunity to respond freely.

How convenient are we in the following areas?

Please rate on a scale of 1- very convenient, 2- somewhat convenient, 3- not convenient

The office currently provides appointments outside of regular business hours on Monday-Thursday 9 AM – 7 PM and every other Saturday 10 AM – 2 PM. Do these days and times meet your needs*
Which of the following appointment time slots would meet your needs?*
Is it easy and convenient to get an appointment?*
When you last telephoned the office, were you treated courteously by the staff?*
When making your last appointment, did the staff work with you to suggest a time and day that was convenient for you?*
When you come into the office, is the staff courteous?*
Are you usually seen in a prompt manner?*
Please rate us on how genuinely interested we seem to be in you as a person.*
During your office visits, do you think we adequately answer your questions?*
Are you satisfied with the quality of medical treatment you receive from us?*
On a scale of 1 to 5, 1 being extremely poor and 5 being excellent, how would you rate your overall experience with our office?*
If needed, did the practice help you connect with services that are unavailable at the practice (specialty care, health insurance enrollment, community resources, etc.)?*
During your most recent visit with a provider, did the provider seem to know the important information about your medical history?*
During your most recent visit with a provider, did this provider’s office do everything they could to make the necessary arrangement if you needed to see another healthcare professional?*
During your most recent visit with a provider, did the provider explain what to do if problems or symptoms continued, got worse, or came back?*
After your most recent visit with a provider, did you know who to call if you needed help or had more questions after you left your appointment?*
In the last 12 months, when your personal doctor sent you for a blood test, x-ray or other test, did someone from the doctor’s office follow up to give you the results?*
If you have to pay for your visit (Sliding fee) has there ever been any time that you did not keep an appointment because you could not afford the fee that you were being charged for our services?*

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