Patient Satisfaction Survey
|
[ Back to the form ]
|
|
|
-
|
.......
|
|
|
1
|
Waiting time in the reception area
|
|
|
2
|
Ease of making appointment for diagnosing services consisting of physical exam, laboratory, Radiology, etc.
|
|
|
3
|
Appointment available within a reasonable amount of time
|
|
|
4
|
Waiting time in the exam room
|
|
|
5
|
Ease of getting a referral when you needed one
|
|
|
6
|
The friendliness and courtesy of the receptionist
|
|
|
7
|
The caring
concern of our nurses/medical assistants
|
|
|
8
|
The professionalism of our lab or x
-ray staff
|
|
|
9
|
Ease of speaking directly with your physician during hospitalization period
|
|
|
10
|
Your phone
calls answered promptly
|
|
|
11
|
Getting advice or help when needed during office hours
|
|
|
12
|
Explanation of your procedure (if applicable)
|
|
|
13
|
Your test results reported in a reasonable amount of time
|
|
|
14
|
Effectiveness of our health information materials
|
|
|
15
|
Taking time to answer your questions
|
|
|
16
|
Amount of time spent with you
|
|
|
17
|
Instructions regarding medication/follow-up care
|
|
|
18
|
Cleanliness of room, bed sheets, blankets, etc
|
|
|
19
|
Quality of heating, cooling, lighting facilities
|
|
|
20
|
Quality of hospital food
|
|
|
21
|
WOULD YOU RECOMMEND THE PROVIDER TO OTHERS?
|
|
|
|
22
|
IF NO, PLEASE TELL US WHY:
|
|
|
23
|
IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT:
|
|
|
24
|
Thanks for your help
|
|
|