Community Medical Clinic - Patient Satisfaction Survey Question Title * 1. Which office was your last appointment? Hopkinsville Oak Grove Princeton Question Title * 2. When was your last appointment? Date / Time Date Question Title * 3. Ease of setting your appointment. Greeting by our receptionist when you arrived.1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 4. The friendliness and courtesy of the receptionists. 1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 5. Cleanliness/Neatness of the waiting room1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 6. Cleanliness/Neatness of the patient exam room. 1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 7. Length of time you had to wait before you were called for your appointment1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 8. Friendliness of our office staff1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 9. Friendliness of the provider, the ability of the provider to put you at ease 1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 10. Quality of service performed1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 11. The degree to which your concerns were addressed by either the nurse or provider1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 12. Receiving lab(s) or test results in a reasonable time. 1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 13. The ease of checking out and paying after the appointment?1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 14. How likely is it that you would recommend our office to your family members, co-workers, and friends? In your own words, let us know any positive experiences you had or issues or concerns you may have about our services or offices practices and procedures.1 - Poor, 2 - Fair, 3 - Good, 4 - Very Good, 5 - Excellent Question Title * 15. In your own words, let us know any positive experiences you had or issues/concerns you may have about our services, office practices and procedures. Question Title * 16. Would you like to provide us with your contact information? Name City/Town Email Address Phone Number Done