Retina Consultants of Southwest Florida

Patient Satisfaction Survey

Question Title

* 1. How did you hear about Retina Consultants of Southwest Florida?

My general eye doctor referred me

My medical doctor referred me

Yellow pages

Dex

Internet Search

Friend or relative

Other (please specify)

Question Title

* 2. Do you visit or utilize any of the following social networking sites? Please select all that apply

Instagram

Facebook

Twitter

I don't use social networking

Other (please specify)

Question Title

* 3. Have you visited Retina Consultants of Southwest Florida's website? www.eye.md

Yes

Question Title

* 4. Have you visited National Ophthalmic Research Institute's website? www.nori.md

Yes

Question Title

* 5. Which office did you visit on your last visit?

Fort Myers

Cape Coral

Naples

Port Charlotte

Bonita Springs

Question Title

* 6. Which physician did you see on your last visit?

Joseph Walker, MD

Paul Raskauskas, MD

Tom Ghuman, MD

Ashish Sharma, MD

Katrina Mears, MD

Donald Fletcher, MD

Question Title

* 7. Please indicate your level of satisfaction concerning the following appointment making steps.

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Dissatisfied	Extremely Dissatisfied	Not Applicable
Courtesy of staff member	Courtesy of staff member Extremely Satisfied	Courtesy of staff member Satisfied	Courtesy of staff member Somewhat Satisfied	Courtesy of staff member Dissatisfied	Courtesy of staff member Extremely Dissatisfied	Courtesy of staff member Not Applicable
Ease in scheduling	Ease in scheduling Extremely Satisfied	Ease in scheduling Satisfied	Ease in scheduling Somewhat Satisfied	Ease in scheduling Dissatisfied	Ease in scheduling Extremely Dissatisfied	Ease in scheduling Not Applicable
Amount of time placed on hold	Amount of time placed on hold Extremely Satisfied	Amount of time placed on hold Satisfied	Amount of time placed on hold Somewhat Satisfied	Amount of time placed on hold Dissatisfied	Amount of time placed on hold Extremely Dissatisfied	Amount of time placed on hold Not Applicable
Music/Dialogue played while on hold	Music/Dialogue played while on hold Extremely Satisfied	Music/Dialogue played while on hold Satisfied	Music/Dialogue played while on hold Somewhat Satisfied	Music/Dialogue played while on hold Dissatisfied	Music/Dialogue played while on hold Extremely Dissatisfied	Music/Dialogue played while on hold Not Applicable
Any questions you had were answered to your satisfaction	Any questions you had were answered to your satisfaction Extremely Satisfied	Any questions you had were answered to your satisfaction Satisfied	Any questions you had were answered to your satisfaction Somewhat Satisfied	Any questions you had were answered to your satisfaction Dissatisfied	Any questions you had were answered to your satisfaction Extremely Dissatisfied	Any questions you had were answered to your satisfaction Not Applicable

Question Title

* 8. Please describe your experience when you first entered our office.

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Dissatisfied	Extremely Dissatisfied	Not Applicable
Greeted promptly	Greeted promptly Extremely Satisfied	Greeted promptly Satisfied	Greeted promptly Somewhat Satisfied	Greeted promptly Dissatisfied	Greeted promptly Extremely Dissatisfied	Greeted promptly Not Applicable
Greeted politely	Greeted politely Extremely Satisfied	Greeted politely Satisfied	Greeted politely Somewhat Satisfied	Greeted politely Dissatisfied	Greeted politely Extremely Dissatisfied	Greeted politely Not Applicable
Checked in quickly	Checked in quickly Extremely Satisfied	Checked in quickly Satisfied	Checked in quickly Somewhat Satisfied	Checked in quickly Dissatisfied	Checked in quickly Extremely Dissatisfied	Checked in quickly Not Applicable
Checked in politely	Checked in politely Extremely Satisfied	Checked in politely Satisfied	Checked in politely Somewhat Satisfied	Checked in politely Dissatisfied	Checked in politely Extremely Dissatisfied	Checked in politely Not Applicable
Any questions you had were answered to your satisfaction	Any questions you had were answered to your satisfaction Extremely Satisfied	Any questions you had were answered to your satisfaction Satisfied	Any questions you had were answered to your satisfaction Somewhat Satisfied	Any questions you had were answered to your satisfaction Dissatisfied	Any questions you had were answered to your satisfaction Extremely Dissatisfied	Any questions you had were answered to your satisfaction Not Applicable

Question Title

* 9. Please describe your experience with your insurance coverage or your account manager during your visit.

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Dissatisfied	Extremely Dissatisfied	Not Applicable
I was advised about my insurance coverage prior to any services rendered	I was advised about my insurance coverage prior to any services rendered Extremely Satisfied	I was advised about my insurance coverage prior to any services rendered Satisfied	I was advised about my insurance coverage prior to any services rendered Somewhat Satisfied	I was advised about my insurance coverage prior to any services rendered Dissatisfied	I was advised about my insurance coverage prior to any services rendered Extremely Dissatisfied	I was advised about my insurance coverage prior to any services rendered Not Applicable
I was given the opportunity to speak with an account manager	I was given the opportunity to speak with an account manager Extremely Satisfied	I was given the opportunity to speak with an account manager Satisfied	I was given the opportunity to speak with an account manager Somewhat Satisfied	I was given the opportunity to speak with an account manager Dissatisfied	I was given the opportunity to speak with an account manager Extremely Dissatisfied	I was given the opportunity to speak with an account manager Not Applicable
Any questions I had were answered to my satisfaction	Any questions I had were answered to my satisfaction Extremely Satisfied	Any questions I had were answered to my satisfaction Satisfied	Any questions I had were answered to my satisfaction Somewhat Satisfied	Any questions I had were answered to my satisfaction Dissatisfied	Any questions I had were answered to my satisfaction Extremely Dissatisfied	Any questions I had were answered to my satisfaction Not Applicable

Question Title

* 10. Please describe your satisfaction with our medical staff.

	Extremely satisfied	Satisfied	Somewhat satisfied	Somewhat dissatisfied	Extremely dissatisfied	Not Applicable
Amount of time waiting prior to being called back initially	Amount of time waiting prior to being called back initially Extremely satisfied	Amount of time waiting prior to being called back initially Satisfied	Amount of time waiting prior to being called back initially Somewhat satisfied	Amount of time waiting prior to being called back initially Somewhat dissatisfied	Amount of time waiting prior to being called back initially Extremely dissatisfied	Amount of time waiting prior to being called back initially Not Applicable
Politeness of staff member checking vision	Politeness of staff member checking vision Extremely satisfied	Politeness of staff member checking vision Satisfied	Politeness of staff member checking vision Somewhat satisfied	Politeness of staff member checking vision Somewhat dissatisfied	Politeness of staff member checking vision Extremely dissatisfied	Politeness of staff member checking vision Not Applicable
Politeness of staff member assisting doctor	Politeness of staff member assisting doctor Extremely satisfied	Politeness of staff member assisting doctor Satisfied	Politeness of staff member assisting doctor Somewhat satisfied	Politeness of staff member assisting doctor Somewhat dissatisfied	Politeness of staff member assisting doctor Extremely dissatisfied	Politeness of staff member assisting doctor Not Applicable
Politeness of doctor	Politeness of doctor Extremely satisfied	Politeness of doctor Satisfied	Politeness of doctor Somewhat satisfied	Politeness of doctor Somewhat dissatisfied	Politeness of doctor Extremely dissatisfied	Politeness of doctor Not Applicable
Testing or procedures explanation	Testing or procedures explanation Extremely satisfied	Testing or procedures explanation Satisfied	Testing or procedures explanation Somewhat satisfied	Testing or procedures explanation Somewhat dissatisfied	Testing or procedures explanation Extremely dissatisfied	Testing or procedures explanation Not Applicable
Diagnosis and potential treatment options explanation	Diagnosis and potential treatment options explanation Extremely satisfied	Diagnosis and potential treatment options explanation Satisfied	Diagnosis and potential treatment options explanation Somewhat satisfied	Diagnosis and potential treatment options explanation Somewhat dissatisfied	Diagnosis and potential treatment options explanation Extremely dissatisfied	Diagnosis and potential treatment options explanation Not Applicable
Patient brochures	Patient brochures Extremely satisfied	Patient brochures Satisfied	Patient brochures Somewhat satisfied	Patient brochures Somewhat dissatisfied	Patient brochures Extremely dissatisfied	Patient brochures Not Applicable
Instructions/Explanation at the end of Appointment	Instructions/Explanation at the end of Appointment Extremely satisfied	Instructions/Explanation at the end of Appointment Satisfied	Instructions/Explanation at the end of Appointment Somewhat satisfied	Instructions/Explanation at the end of Appointment Somewhat dissatisfied	Instructions/Explanation at the end of Appointment Extremely dissatisfied	Instructions/Explanation at the end of Appointment Not Applicable

Question Title

* 11. Is this your first visit to Retina Consultants of Southwest Florida?

Yes

Question Title

* 12. Approximately how long did you wait before being examined by your doctor?

30 minutes or less

45 minutes

1 hour

1 hour 30 minutes

2 hours

2 hours 30 minutes

3 hours

More than 3 hours

Question Title

* 13. In your opinion, was the amount of time spent with the doctor sufficient?

Yes

Question Title

* 14. Please describe your check out experience.

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Dissatisfied	Extremely Dissatisfied	Not Applicable
Checked out promptly	Checked out promptly Extremely Satisfied	Checked out promptly Satisfied	Checked out promptly Somewhat Satisfied	Checked out promptly Dissatisfied	Checked out promptly Extremely Dissatisfied	Checked out promptly Not Applicable
Checked out politely	Checked out politely Extremely Satisfied	Checked out politely Satisfied	Checked out politely Somewhat Satisfied	Checked out politely Dissatisfied	Checked out politely Extremely Dissatisfied	Checked out politely Not Applicable
Ease of scheduling next appointment	Ease of scheduling next appointment Extremely Satisfied	Ease of scheduling next appointment Satisfied	Ease of scheduling next appointment Somewhat Satisfied	Ease of scheduling next appointment Dissatisfied	Ease of scheduling next appointment Extremely Dissatisfied	Ease of scheduling next appointment Not Applicable

Question Title

* 15. At checkout, were you offered a copy of the summary of your visit?

Yes

Question Title

* 16. To improve communication for a better patient experience, we have created an online Patient Portal where you can access information about each of your visits and communicate directly with your doctor electronically. Please describe your experience with our Patient Portal:

I was never provided information about my Patient Portal.

I was given information about how to access my Patient Portal, but I am not interested in doing this.

I was given information about the Patient Portal and have set up my account, but I have only accessed my visit information.

I was given information about the Patient Portal, have set up my account, have accessed my visit information, and have communicated directly with my doctor.

Other (please specify)

Question Title

* 17. For future appointments: If a payment is required at the time of service (for example, a co-pay), I prefer to pay via:

Cash

Check

Credit or Debit Card

Question Title

* 18. In an attempt to improve efficiency for a better patient experience, if the option of paying cash was eliminated, I would:

Be happy to pay by check or credit/debit card

Not care one way or another

Be greatly inconvenienced by having to pay by check or credit/debit card

Question Title

* 19. We hope that you will take a moment to share any other experiences so that we may better serve you in the future. We sincerely value your opinion and would appreciate any comments that you are willing to provide.

Question Title

* 20. Please describe the appearance/hospitality of our office.

	Extremely Satisfied	Satisfied	Somewhat Satisfied	Dissatisfied	Extremely Dissatisfied	Not Applicable
Decor	Decor Extremely Satisfied	Decor Satisfied	Decor Somewhat Satisfied	Decor Dissatisfied	Decor Extremely Dissatisfied	Decor Not Applicable
Cleanliness	Cleanliness Extremely Satisfied	Cleanliness Satisfied	Cleanliness Somewhat Satisfied	Cleanliness Dissatisfied	Cleanliness Extremely Dissatisfied	Cleanliness Not Applicable
Refreshments	Refreshments Extremely Satisfied	Refreshments Satisfied	Refreshments Somewhat Satisfied	Refreshments Dissatisfied	Refreshments Extremely Dissatisfied	Refreshments Not Applicable
Restrooms	Restrooms Extremely Satisfied	Restrooms Satisfied	Restrooms Somewhat Satisfied	Restrooms Dissatisfied	Restrooms Extremely Dissatisfied	Restrooms Not Applicable
Lighting	Lighting Extremely Satisfied	Lighting Satisfied	Lighting Somewhat Satisfied	Lighting Dissatisfied	Lighting Extremely Dissatisfied	Lighting Not Applicable
Television stations in the waiting areas	Television stations in the waiting areas Extremely Satisfied	Television stations in the waiting areas Satisfied	Television stations in the waiting areas Somewhat Satisfied	Television stations in the waiting areas Dissatisfied	Television stations in the waiting areas Extremely Dissatisfied	Television stations in the waiting areas Not Applicable
Noise Level	Noise Level Extremely Satisfied	Noise Level Satisfied	Noise Level Somewhat Satisfied	Noise Level Dissatisfied	Noise Level Extremely Dissatisfied	Noise Level Not Applicable

Question Title

* 21. Please describe your experience in our office overall.

	Strongly Agree	Agree	Somewhat Agree	Disagree	Strongly Disagree	Not Applicable
Do you feel as if we respected your privacy/personal Information?	Do you feel as if we respected your privacy/personal Information? Strongly Agree	Do you feel as if we respected your privacy/personal Information? Agree	Do you feel as if we respected your privacy/personal Information? Somewhat Agree	Do you feel as if we respected your privacy/personal Information? Disagree	Do you feel as if we respected your privacy/personal Information? Strongly Disagree	Do you feel as if we respected your privacy/personal Information? Not Applicable
Would you recommend Retina Consultants to your family or friends?	Would you recommend Retina Consultants to your family or friends? Strongly Agree	Would you recommend Retina Consultants to your family or friends? Agree	Would you recommend Retina Consultants to your family or friends? Somewhat Agree	Would you recommend Retina Consultants to your family or friends? Disagree	Would you recommend Retina Consultants to your family or friends? Strongly Disagree	Would you recommend Retina Consultants to your family or friends? Not Applicable
Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices?	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Strongly Agree	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Agree	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Somewhat Agree	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Disagree	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Strongly Disagree	Do you feel as if your experience at Retina Consultants was as good as, if not better compared to other doctors' offices? Not Applicable

If there is something positive that you have noticed about other doctors' offices that you would like to see implemented at Retina Consultants of Southwest Florida, please let us know here:

Question Title

* 22. Were there any staff member(s) that were memorable during your visit? Please provide the name and why:

Question Title

* 23. In an attempt to improve efficiency for a better patient experience, we are considering texting or emailing appointment reminders and billing statements. How would you prefer to receive this information?

Text

Both email and text

I prefer you continue calling and mailing this information

Question Title

* 24. For the purpose of improving our service, may we contact you in regard to this survey? (Any information that you share will not become a part of your medical record and will be kept anonymous by the person who contacts you.)

Yes-Please enter your name and phone number below