1. 

I was able to schedule an appointment as soon as I wanted.

 

2. 

Changes to my appointment were communicated courteously and promptly.

 

3. 

The check-in process was a pleasant experience.

 

4. 

Information and education on medications was appropriate and complete.

 

5. 

Coordination of follow-up care was handled in an outstanding fashion.

 

6. 

The billing and insurance process was well explained, timely and convenient.

 

7. 

My provider spent adequate time with me.

 

8. 

My provider was sensitive to my needs and listened to what I said.

 

9. 

My provider clearly communicated the diagnosis and plan.

 

10. 

I have confidence and trust in the provider who treated me.

 

11. 

My provider was courteous.

 

12. 

Overall, I am satisfied with the care I received from my provider.

 

13. 

The person with whom I spoke about my appointment was courteous.

 

14. 

The front office staff treated me courteously.

 

15. 

I was treated with respect and dignity by the examining room staff.

 

16. 

The staff was responsive to my concerns.

 

17. 

The staff was sensitive to my privacy.

 

18. 

The staff was responsive to the needs of my family.

 

19. 

The appearance and neatness of staff was excellent.

 

20. 

The appearance and neatness of the practice was excellent.

 

21. 

The reception area was comfortable.

 

22. 

Waiting time in the front office area was appropriate.

 

23. 

Any delays were explained to my satisfaction.

 

24. 

I will recommend this practice to family and friends.

 

25. 

You will be my first choice if I need your specialty in the future.

 

26. 

My wait in the examining room was appropriate.

 

27. 

The check-out process was a pleasant experience.

 

28. 

Overall, my experience was excellent.

 

29. 

Please share one thing you would have us change to improve your experience.

 

30. 

Please share the best thing about your visit.

 

31. 

Please name a staff member who was especially helpful.

 

32. 

Please share any additional comments. If you would like someone to contact you to discuss your feedback, please include your contact information. Thank You!