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Please tell us how SATISFIED you were with the following: |
Completely
Satisfied |
Very
Satisfied |
Mostly
Satisfied |
Somewhat
Satisfied |
Not
Satisfied |
The courtesy of the person who scheduled your appointment |
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The ease of scheduling your appointment |
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How welcoming the staff were to you |
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How convenient parking was |
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The cleanliness of the waiting room and exam area |
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The amount of time you waited to get a scheduled appointment
with the doctor |
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The amount of time you waited to see the doctor after you
arrived at the office |
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How kind and courteous your doctor was |
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How kind and courteous your nurse was |
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Your doctor's skills and abilities |
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Your nurse's skills and abilities |
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The amount of time your doctor spent with you |
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How well your doctor explained your tests and treatment |
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How well the doctor listened to your concerns |
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How well the nurse listened to your concerns |
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How well your doctor explained how to take care of yourself at
home |
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The overall quality of medical care provided to you |
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Were you able to make the appointment as soon as you wanted? |
Yes |
No |
How many days did you wait for your appointment after calling to
schedule? (Type in days) |
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Please tell us how SATISFIED you were with the following: |
Completely
Satisfied |
Very
Satisfied |
Mostly
Satisfied |
Somewhat
Satisfied |
Not
Satisfied |
Not
Applicable |
The courtesy of the person who registered you took your
insurance information |
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How quickly your registration and insurance information was
taken |
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If you had blood sampled: |
The amount of time you waited |
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The ability of the person who took your sample |
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If you had a mammogram: |
The amount of time you waited |
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The ability of the person who took your mammogram |
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If you called our billing office (Office of Professional
Services) with a question or concern? |
Completely
Satisfied |
Very
Satisfied |
Mostly
Satisfied |
Somewhat
Satisfied |
Not
Satisfied |
Not
Applicable |
How quickly your call was answered: |
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How courteous the person was who handled your call: |
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How quickly your question or problem was resolved: |
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Since your visit, have you called the doctor's office for any
reason, such as for questions or concerns?: |
Yes |
No |
If YES: |
How quickly your call was answered: |
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How courteous the person was who handled your call: |
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Which of the following describe how you chose or were sent to your
OB-GYN doctor? (check all that apply to you) |
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Reputation of the doctor: |
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My
doctor sent me: |
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Family member or friend recommendation: |
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Insurance company referred me: |
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Called the Referral Assistance Service: |
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Found name in yellow pages: |
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