Sleep Study - Patient Satisfaction Survey
In an effort to ensure quality patient care, we would appreciate your time to answer the following questions. Please be forthright and honest so that we can continue areas of strength and improve areas of weakness.
Were you told by your physician why you were coming to our facility?
Clear selection
When calling our office, was the staff friendly and helpful?
Clear selection
Did you receive instructions regarding location and appointment information?
Clear selection
Were you notified of your financial responsibility prior to scheduling your study?
Clear selection
Did you feel safe coming to our office?
Clear selection
If you didn't feel safe coming to our office, please explain:
Please rate our facility:
Excellent
Good
Fair
Poor
N/A
Decor
Restroom facilities
Bedroom comfort
Cleanliness
Temperature
Clear selection
Please rate our staff:
Excellent
Good
Fair
Poor
N/A
Knowledge of office staff
Promptness to fulfill needs
Willingness to assist you
Knowledge of technical staff
Clear selection
Please rate our procedures:
Excellent
Good
Fair
Poor
N/A
Scheduling procedures
Technical staff's set-up procedures
Clinical staff's CPAP demonstration/explanation
Electrode removal/clean-up after study
Clear selection
Extremely satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Extremely dissatisifed
Overall, how satisfied were you with the care received at our facility?
Clear selection
Please list any additional comments regarding staff, facility, or procedures. We welcome suggestions for improvement.
Patient Name (optional)
Date of appointment (required) *
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