Patient Satisfaction Survey


Tracking code of this form: P507-F570-U0-N252927          
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Waiting time in the reception area
 Excellent
 Good
 Ok
 Poor
Ease of making appointment for diagnosing services consisting of physical exam, laboratory, Radiology, etc.
 Excellent
 Good
 Ok
 Poor
Appointment available within a reasonable amount of time
 Excellent
 Good
 Ok
 Poor
Waiting time in the exam room
 Excellent
 Good
 Ok
 Poor
Ease of getting a referral when you needed one
 Excellent
 Good
 Ok
 Poor
The friendliness and courtesy of the receptionist
 Excellent
 Good
 Ok
 Poor
The caring concern of our nurses/medical assistants
 Excellent
 Good
 Ok
 Poor
The professionalism of our lab or x -ray staff
 Excellent
 Good
 Ok
 Poor
Ease of speaking directly with your physician during hospitalization period
 Excellent
 Good
 Ok
 Poor
Your phone calls answered promptly
 Excellent
 Good
 Ok
 Poor
Getting advice or help when needed during office hours
 Excellent
 Good
 Ok
 Poor
Explanation of your procedure (if applicable)
 Excellent
 Good
 Ok
 Poor
Your test results reported in a reasonable amount of time
 Excellent
 Good
 Ok
 Poor
Effectiveness of our health information materials
 Excellent
 Good
 Ok
 Poor
Taking time to answer your questions
 Excellent
 Good
 Ok
 Poor
Amount of time spent with you
 Excellent
 Good
 Ok
 Poor
Instructions regarding medication/follow-up care
 Excellent
 Good
 Ok
 Poor
Cleanliness of room, bed sheets, blankets, etc
 Excellent
 Good
 Ok
 Poor
Quality of heating, cooling, lighting facilities
 Excellent
 Good
 Ok
 Poor
Quality of hospital food
 Excellent
 Good
 Ok
 Poor
WOULD YOU RECOMMEND THE PROVIDER TO OTHERS?
 yes
 no
IF NO, PLEASE TELL US WHY:
IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT:
Thanks for your help

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