Patient Satisfaction Survey

Initial Visit

ExcellentGoodFairNeeds Work

Introduction to Office Excellent Good Fair Needs Work

Interview Excellent Good Fair Needs Work

Doctor’s Exam Excellent Good Fair Needs Work

Financial Discussions Excellent Good Fair Needs Work

Questions Answered Excellent Good Fair Needs Work

Reception Areas

ExcellentGoodFairNeeds Work

Telephone Calls Excellent Good Fair Needs Work

Staff Hospitality Excellent Good Fair Needs Work

Areas Neat and Clean Excellent Good Fair Needs Work

Insurance Handling Excellent Good Fair Needs Work

Special Requests Excellent Good Fair Needs Work

Treatment Areas

ExcellentGoodFairNeeds Work

Care and Empathy Excellent Good Fair Needs Work

Courtesy and Response Excellent Good Fair Needs Work

Helpfulness Excellent Good Fair Needs Work

Competence/Knowledge Excellent Good Fair Needs Work

Cleanliness Excellent Good Fair Needs Work

General Comments

ExcellentGoodFairNeeds Work

Professionalism Excellent Good Fair Needs Work

Personal Comforts Excellent Good Fair Needs Work

Office Atmosphere Excellent Good Fair Needs Work

Based on your experience, would
you recommend our office to your
family and friends?

DefinitelyYesMaybeNoNever

 Definitely Yes Maybe No Never

We are committed to excellence. We can only improve if we know where we need improvement. Please use the box below to tell us how we can achieve a more “excellent” status.

Enter your name and email address or phone number if you would like to hear from us in regards to your answers and how we can improve.

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