Post-Visit Patient Satisfaction Template

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50% of survey complete.

Question Title

1. At which office location were you seen?

Bethel Park Location

Peters Township/McMurray

Waterfront/Homestead

Route 51 Office

Question Title

2. 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

Question Title

3. Overall, how would you rate our telephone service when calling our office?

Excellent - calls answered within 3 rings

Very good - calls answered within 5 rings with no holds experienced

Good - call answered within 5 rings with minimal hold experienced

Fair - call answered in more than 10 rings with no hold experienced

Poor - call answered in more than 10 rings and hold experienced

Question Title

4. How comfortable was the lobby and waiting area?

Extremely comfortable

Very comfortable

Moderately comfortable

Slightly comfortable

Not at all comfortable

Question Title

5. Overall, how would you rate the cleanliness of the lobby, office area and exam room?

Immaculate - all areas absolutely spotless

Very clean - all areas well cleaned - some minor cleanliness issues

Generally clean - cleanliness issues in one area noted

Not well cleaned - noticeable cleanliness issues in multiple areas

Question Title

6. Did your appointment with your provider start early, late or on time?

Very early

Somewhat early

On time

Somewhat late

Very late

Question Title

7. If your appointment did not start at the scheduled time, how often did someone tell you why there was a delay or how long the delay would be?

Never

Sometimes

Usually

Always

Question Title

8. Overall, how would you rate the staff's introduction of themselves

Excellent - all staff introduced themselves

Good - most staff introduced themselves

Fair - some staff introduced themselves

Poor - no staff introduced themselves

Question Title

9. Overall, how would you rate the courtesy/friendliness of our staff during your visit?

Excellent

Very good

Good

Fair

Poor

Question Title

10. How well did the staff work together to care for you?

Extremely well

Very well

Moderately well

Slightly well

Not at all well

Question Title

11. 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

Question Title

12. 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

Question Title

13. How likely is it that you would recommend your provider to a friend or colleague?

Not at all likely

Extremely likely

Question Title

14. Is there anything we could have done to improve your last visit?

Question Title

15. Address

Name

ZIP/Postal Code

Email Address

Phone Number