Patient Satisfaction Survey
Wall Family Medical & Howell Family Medical
A) Your age range
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B) Insurance Type
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C) How would you rate your overall health?
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D) Your provider
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#1) In the last 12 months, how often did this provider explain things in a way that was easy to understand?
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#2) In the last 12 months, how often did this provider listen carefully to you?
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#3) In the last 12 months, how often did this provider seem to know the important information about you medical history?
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#4) In the last 12 months, how often did this provider spend enough time with you?
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#5) In the last 12 months, how often did this provider's office talk with you about specific goals for your health?
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#6) In the last 12 months, did anyone in this provider's office ask you if there are things that make it hard for you to take care of your health?
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#7) In the last 12 months, did you and this provider talk about starting or stopping a prescription medicine? If No, go to #10
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#8) When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might want to take a medicine?
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#9) When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might NOT want to take a medicine?
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#10) Did this provider's office give you information about what to do if you needed care during evenings, weekends, or holidays?
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#11) In the last 12 months, did you phone this provider's office with a medical question during regular office hours? If No, go to #13
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#12) In the last 12 months, when you phone this provider's office during regular office hours, how often did you get an answer to your medical question that same day?
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#13) In the last 12 months, did you phone this provider's office AFTER regular office hours? If No, go to #15
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#14) In the last 12 months, when you phone this provider's office during regular office hours, how often did you get an answer to your medical question as soon as you need?
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#15) What has been your overall experience with the personnel at the Front Desk?
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#16) What has been your overall experience with the courtesy of person who answers yours calls?
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#17) Does the staff acknowledge your arrival to the office and address your needs promptly?
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#18) What has been your overall experience with the Nursing Staff?
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#19) Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your provider indicated on the top of this survey?
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#20) If you could suggest one thing for us to focus on improving, what would that be?
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