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Post-Visit Patient Satisfaction Survey - QTR 3, 2023
1.
On a scale of 0 to 10,
How likely is it that you would recommend your provider to a friend or family member?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
2.
Overall, how satisfied or dissatisfied were you with your last visit to our office?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
3.
How easy or difficult was it to schedule your appointment at a time that was convenient for you?
Very easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Very difficult
4.
How convenient was the appointment time you were able to get?
Extremely convenient
Very convenient
Somewhat convenient
Not so convenient
Not at all convenient
5.
In your opinion, how convenient is the location of our office?
Extremely convenient
Very convenient
Somewhat convenient
Not so convenient
Not at all convenient
6.
Overall, how would you rate the service you received from the staff at our office?
Excellent
Very good
Good
Fair
Poor
7.
How comfortable was the lobby and waiting area?
Extremely comfortable
Very comfortable
Somewhat comfortable
Not so comfortable
Not at all comfortable
8.
Did your appointment with your provider start early, late or on time?
Very early
Somewhat early
On time
Somewhat late
Very late
9.
Overall, how would you rate the care you received from your provider?
Excellent
Very good
Good
Fair
Poor
10.
How much do you trust your provider to make medical decisions that are in your best interests?
A great deal
A lot
A moderate amount
A little
Not at all
11.
How well did your provider listen to your needs?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
12.
How well did your provider answer your questions?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
13.
How well did your provider explain your treatment options?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
14.
How well did your provider explain your follow-up care?
Extremely well
Very well
Somewhat well
Not so well
Not at all well
15.
Do you feel your overall wellness is considered and addressed in the decision-making process during your visit? (Overall wellness includes mental, emotional, physical, and spiritual health.)
Yes
No
16.
How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
17.
Which provider did you see at your most recent office visit?
Dr. Chambers
Dr. Burns
Dr. Emry
Dr. Mills
Dr. Weatherly
Dr. Walsworth
Aaron Drapeau, ARNP
Dr. Thompson
18.
For your most recent visit, were you seen in the office or via Telemedicine?
In office
Telemedicine
19.
If you were seen via telemedicine, how likely are you to use this visit method again?
Very likely
Likely
Somewhat likely
Neither likely nor unlikely
Somewhat unlikely
Unlikely
Very unlikely
Not applicable
20.
Do you feel it would be beneficial for our clinic to offer appointments after 5pm?
Yes
No
21.
Do you feel if would be beneficial for the clinic to offer weekend appointments?
Yes
No
22.
Are there any additional services you would like to see offered at Ironwood Family Practice?
23.
Is there anything we could have done to improve your last visit?
24.
Please select your age group below.
Under 18
18-24
25-34
35-44
45-54
55-64
65+
25.
Please select your legal gender below.
Female
Male
Current Progress,
0 of 25 answered
