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