Womens OBGYN Care PLLC
Patient Satisfaction Survey
Patient Information
Name *
First Name Last Name
Your answer
Appointment Scheduling
Poor
Okay
Average
Great
Was your call answered promptly?
Did the scheduler greet you in a friendly manner?
Was your appointment scheduled within a reasonable time frame?
Check-in
Poor
Okay
Average
Great
Did the receptionist greet you with a smile?
Were you kept informed of any delays?
Clinical Area
Poor
Okay
Average
Great
Did the medical assistant greet you warmly?
Did the medical assistant seem knowledgeable?
Were your questions answered adequately?
Quality of Care
Poor
Okay
Average
Great
Did your provider listen to your concern(s)?
Did your provider explain your diagnosis thoroughly?
Did your provider use language you could understand?
Did you feel your problem(s) were addressed adequately?
Wait Times
How long did you wait in the reception area? *
How long did you wait in the exam room? *
Recommendation
Would you recommend this practice to friend and family? *
Additional Comments?
Your answer
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