Patient Feedback Survey We value your feedback. Please take a moment to share your experience with us. Step 1 of 8 12% Feedback on Scheduling and AppointmentsHow easy was it to schedule your appointment with us?(Required) Very Easy Easy Neutral Difficult Very Difficult Were you able to make an appointment at a time that was convenient for you?(Required) Yes No How would you rate the courtesy of the staff member who scheduled your appointment? (1 = Poor, 5 = Excellent)(Required) 1 2 3 4 5 Did you receive a timely reminder for your appointment?(Required) Yes No Feedback on Your Arrival and the Waiting RoomUpon arrival, how long did you wait before being checked in?(Required) Less than 5 minutes 5-15 minutes 15-30 minutes More than 30 minutes Please rate the cleanliness and comfort of our waiting area. (1 = Poor, 5 = Excellent)(Required) 1 2 3 4 5 Was the front-desk staff welcoming and helpful upon your arrival?(Required) Yes No If you had questions for the front-desk staff, were they answered to your satisfaction?(Required) Yes No Not Applicable Was the signage in our facility clear and easy to understand?(Required) Yes No Feedback on Your Healthcare Provider (Physician, Nurse, Specialist)How would you rate the amount of time your provider spent with you?(Required) Excellent Good Fair Poor Did your provider listen carefully to your health concerns?(Required) Always Usually Sometimes Never Did your provider explain things in a way that was easy to understand?(Required) Always Usually Sometimes Never Did you feel your provider showed genuine concern for your well-being?(Required) Yes No Did you have confidence in your provider's ability to treat you? (1 = No confidence, 5 = Full confidence)(Required) 1 2 3 4 5 Were you involved in decisions about your treatment and care plan?(Required) Yes No Feedback on the Nursing and Clinical StaffPlease rate the professionalism and courtesy of the nursing staff. (1 = Poor, 5 = Excellent)(Required) 1 2 3 4 5 Did the clinical staff clearly explain the procedures or tests they were performing?(Required) Yes No Did you feel comfortable asking the nursing staff questions?(Required) Yes No How would you rate the responsiveness of the clinical team to your needs?(Required) Excellent Good Fair Poor Feedback on Diagnosis and Treatment CommunicationClarity in communication is paramount for patient trust and a positive experience.Did your provider clearly explain your diagnosis or condition?(Required) Yes No Were the benefits and risks of your treatment options explained to you?(Required) Yes No Did you receive clear instructions regarding your medications?(Required) Yes No Not Applicable Were you informed about the next steps in your care plan?(Required) Yes No Did you have enough opportunity to ask questions about your treatment?(Required) Yes No Feedback on the Facility and EnvironmentThe physical space contributes to the overall sense of comfort and quality.Please rate the overall cleanliness of our facility. (1 = Poor, 5 = Excellent)(Required) 1 2 3 4 5 Was the equipment used during your visit modern and clean?(Required) Yes No Did you feel our facility provided a safe and private environment?(Required) Yes No Feedback on Billing and PaymentFinancial interactions can be a major point of friction if not handled well.Was the billing and payment process explained clearly to you?(Required) Yes No Not Applicable How would you rate the helpfulness of our billing department staff?(Required) 1 - Poor 2 3 - Average 4 5 - Excellent Not Applicable Were the invoices you received from us easy to understand?(Required) Yes No Not Applicable Feedback on Overall Experience and LoyaltyThese questions measure the holistic impression and predict future patient behavior.Based on your recent visit, how likely are you to recommend our practice to a friend or family member? (0 = Not at all likely, 10 = Extremely likely)(Required) 0 1 2 3 4 5 6 7 8 9 10 What is the one thing we could do to improve your experience with us?Please rate your overall satisfaction with the care you received today. (1 = Very Dissatisfied, 5 = Very Satisfied)(Required) 1 2 3 4 5 Will you be returning to our practice for your future healthcare needs?(Required) Yes No Unsure
