| 1) |
The staff's helpfulness in scheduling my appointment was: |
|
| 2) |
The convenience of office hours was: |
|
| 3) |
The staff's courtesy was: |
|
| 4) |
The staff's promptness and efficiency were: |
|
| 5) |
The length of time, if any, that I had to wait past my appointment time was: |
|
| 6) |
The nurse/medial assistant's skill when taking my blood sample, blood pressure, weight, temperature, etc was: |
|
| 7) |
The nurse/medial assistant's care was: |
|
| 8) |
The length of time I had to wait in the examination room before I saw the doctor was: |
|
| 9) |
The doctor's interest in my overall health was: |
|
| 10) |
The doctor's thoroughness in examining me was: |
|
| 11) |
The doctor's explanation of my diagnosis: |
|
| 12) |
The clarity and thoroughness of the doctor's discussion with me about treatment options were: |
|
| 13) |
The doctor's encouragement to call if I had any problems or questions was: |
|
| 14) |
The length of time my doctor spent with me was: |
|
| 15) |
The staff's help with scheduling any follow-up visits, referrals, or tests was: |
|
| 16) |
The staff's explanation of billing and payment/insurance issues was: |
|
| 17) |
The staff's respect for my privacy was: |
|
| 18) |
The doctor's ability to meet my needs was: |
|
| 19) |
My overall satisfaction with the quality of care I received during this visit was: |
|
| 20) |
My willingness to recommend this physician and practice to a close friend or family member is: |
|
| Health Status |
|
| 21) |
Overall, my health is: |
|
| 22) |
The primary reason for my visit was: |
|
| 23) |
Insurance: |
|
| 24) |
Age: |
|
| 25) |
Gender: |
|
| 26) |
Education: |
|
| |
|
|
|
|
