Patient Satisfaction Survey
Thank you for visiting Atlantic Urology Clinics. Please help us improve the patient experience by taking our quick online Patient Satisfaction Survey, and tell us how we did during your visit with us. We value your input as we consistently strive to provide high quality patient care!

This survey will provide us with valuable information on how we can enhance our services. All submissions are anonymous therefore if you wish to be contacted about your response, please leave your name and phone number in the additional comments section of the last question.

Medical information, test results and prescription requests must be handled with your doctor's nurse and can not be handled through this survey.

Date of your visit:
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DD
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How did you hear about Atlantic Urology Clinics?
Which Atlantic Urology Clinics location did you visit?
What doctor did you see?
Please rate each item below. Please select one response for each. If something doesn’t apply to you, please select “N/A."
Before your visit, how would you rate the...
Excellent
Very good
Good
Fair
Poor
N/A
Ease in getting through to the doctor's office by phone?
Courtesy of the staff handling your call?
Availability of medical staff to speak on the phone during office hours?
Time between making an appointment and the day of your visit?
Ease in seeing the doctor of your choice?
Convenience of the location of the doctor's office?
QUALITY OF CARE
Thinking about the quality of care that you received during your last visit to Atlantic Urology Clinics, please rate each item below. Please select one response for each. If something doesn’t apply to you, please select “N/A."
At the time of your visit how would you rate the...
Much worse than expected
Worse than expected
As expected
Better than expected
Much better than expected
N/A
Choose not to answer
Thoroughness of examination
Correctness of diagnosis by physician
Clear explanation of your condition to you
Clear explanation of your treatment plan
Clear explanation of prescriptions
All necessary tests performed as needed
Thoroughness of the treatment received
Quality of advice given by physician
The amount of time the physician spent with you
Quality of care provided by physician’s assistant or nurse practitioner
Overall, how satisfied are you with the quality of care you received at Atlantic Urology Clinics?
Extremely Dissatisfied
Extremely Satisfied
OVERALL PATIENT SATISFACTION & OUTCOMES: Thinking about the total experience, how would you rate your OVERALL SATISFACTION with your last visit to Atlantic Urology Clinics? Please select one.
Extremely Dissatisfied
Extremely Satisfied
How likely are you to recommend this physician to family members or friends? Please select one.
Extremely Dissatisfied
Extremely Satisfied
If the opportunity arose, how likely are you to switch to a different physician in the next six months? Please select one
Extremely Dissatisfied
Extremely Satisfied
If there were a negative experience, such as the physician canceling your appointment, how likely would you be to lodge a complaint about this physician to the practice or office manager? Please select one.
Extremely Dissatisfied
Extremely Satisfied
If there were a negative experience, such as the physician canceling your appointment, how likely would you be to complain about this physician to your family members or friends? Please select one.
Extremely Dissatisfied
Extremely Satisfied
Please indicate your age.
Please indicate your gender.
Please indicate your 5 digit zip code.
Your answer
How would you describe your overall state of health?
How would you rate your overall quality of life?
How satisfied are you with your health status? Please select one
If you would like to stay connected with AUC by email, please type your email address here:
Your answer
Would you like to speak with someone about your experience?
Any additional comments and/or suggestions to improve our service are greatly appreciated.
Your answer
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