Patient Satisfaction Survey

Our goal is to provide a positive experience for you and your children, as well as the best medical care to all of our patients at every visit. We are using this survey to help improve our appointment availability and customer satisfaction. Your responses are anonymous and strictly confidential and will help to improve the patient experience in our office. Thank you for your valuable feedback.

Today's Date

If Other, Please specify

Do you know we have a patient portal, https://sweetwaterpedlatrics.patientmedrecords.com

Yes No

A. YOUR APPOINTMENT

1. Ease of making appointments by phone

Excellent Great Good Fair Poor N/A

2. Requested appointment time availability

Excellent Great Good Fair Poor N/A

3. Getting care for illness/injury as soon as desired

Excellent Great Good Fair Poor N/A

4. Getting after-hours care when desired

Excellent Great Good Fair Poor N/A

5. Waiting time In the reception room

Excellent Great Good Fair Poor N/A

6. Waiting time In the exam room

Excellent Great Good Fair Poor N/A

7. Ease of getting a referral (if needed)

Excellent Great Good Fair Poor N/A

B. OUR STAFF

1. The courtesy of the person who took your call

Excellent Great Good Fair Poor N/A

2. The friendliness and courteousness of the receptionist

Excellent Great Good Fair Poor N/A

3. The caring concern of our nurses/medical assistants

Excellent Great Good Fair Poor N/A

4. The helpfulness of the billing staff

Excellent Great Good Fair Poor N/A

C. OUR COMMUNICATION WITH YOU:

1. Promptness of answering your phone call

Excellent Great Good Fair Poor N/A

2. Getting advice or help during office hour

Excellent Great Good Fair Poor N/A

3. Amount of time to get test results

Excellent Great Good Fair Poor N/A

4. Ability to return calls in a timely manner

Excellent Great Good Fair Poor N/A

5. Ability to obtain prescription refills by phone

Excellent Great Good Fair Poor N/A

D.YOUR VISIT WITH THE PROVIDER:

1. Willingness to listen carefully to you

Excellent Great Good Fair Poor N/A

2. Taking time to answer your questions

Excellent Great Good Fair Poor N/A

3. Explaining things in a way you could understand

Excellent Great Good Fair Poor N/A

4. Instructions regarding medication/follow-up care

Excellent Great Good Fair Poor N/A

5. Advice given to you on ways to stay healthy

Excellent Great Good Fair Poor N/A

E.OUR FACILITY:

1. Convenience of hours of operation

Excellent Great Good Fair Poor N/A

2. Overall comfort

Excellent Great Good Fair Poor N/A

3. Overall cleanliness

Excellent Great Good Fair Poor N/A

F.YOUR OVERALL SATISFACTION WITH:

1. Our practice

Excellent Great Good Fair Poor N/A

2. The quality of your medical care

Excellent Great Good Fair Poor N/A

3. The care from your provider or nurse

Excellent Great Good Fair Poor N/A

4. Access to community resources

Excellent Great Good Fair Poor N/A

WOULD YOU RECOMMEND THE PROVIDER TO OTHERS?

Yes No

WOULD YOU RECOMMEND THE PRACTICE TO OTHERS?

Yes No

IF NO, PLEASE TELL US WHY

IS THERE ANYTHING WE COULD DO TO IMPROVE YOUR EXPERIENCE WITH US? PLEASE TELL US ABOUT IT

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