PATIENT SATISFACTION SURVEY

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Patient Satisfaction Survey

Click here to download the PDF version of this survey or fill it out electronically below

Your opinions as our patients are important to us. We want to know how we are doing. The good and what we can do better. Please take a couple of minutes to provide us with important information to assist us in our efforts to better serve you as our patient.

Please rate us from 1 to 5 using the scale below
1. Inadequate – 2. Adequate – 3. Favorable – 4. Very Favorable – 5. Excellent – NA. Not Applicable

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

How easy was it to make an initial appointment?*
How would you rate our customer service?*

How would you rate the receptionist:
Making you feel welcomed?*
Were they Helpful?*
Professionalism?*
Respectfulness?*
Thoroughness of obtaining all necessary information?*
How would you rate the amount of time you had to wait in the reception area prior to be taken back to the exam room?*

How would you rate the medical assistant:
Greeted you with a smile?*
Professionalism?*
Listening to your needs?*
Caring?*
Courteous?*
Maintaining your privacy?*

How would you rate your provider:
Which Physician did you see today?*
How would you rate the time the Physician spent with you?*
Were you satisfied with the Physician’s explanation of your health condition and/or reason for your visit?*
Your satisfaction with the overall cleanliness and comfort of the facility?*
Would you recommend this practice to your family and friends?*

Thank you for your honesty and we look forward to seeing you again soon – The Medical Partners Group