Patient Feedback Survey - Arroyo Vista Family Medicine

	Extremely Dissatisfied	Very Dissatisfied	Somewhat Dissatisfied	Satisfied	Very Satisfied	Extremely Satisfied
The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments)	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Extremely Dissatisfied	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Very Dissatisfied	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Somewhat Dissatisfied	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Satisfied	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Very Satisfied	The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Extremely Satisfied
Ease of making same-day/sick visit appointments?	Ease of making same-day/sick visit appointments? Extremely Dissatisfied	Ease of making same-day/sick visit appointments? Very Dissatisfied	Ease of making same-day/sick visit appointments? Somewhat Dissatisfied	Ease of making same-day/sick visit appointments? Satisfied	Ease of making same-day/sick visit appointments? Very Satisfied	Ease of making same-day/sick visit appointments? Extremely Satisfied
The time it takes someone from our office to respond when you call the office with an urgent problem?	The time it takes someone from our office to respond when you call the office with an urgent problem? Extremely Dissatisfied	The time it takes someone from our office to respond when you call the office with an urgent problem? Very Dissatisfied	The time it takes someone from our office to respond when you call the office with an urgent problem? Somewhat Dissatisfied	The time it takes someone from our office to respond when you call the office with an urgent problem? Satisfied	The time it takes someone from our office to respond when you call the office with an urgent problem? Very Satisfied	The time it takes someone from our office to respond when you call the office with an urgent problem? Extremely Satisfied
Waiting time in our office?	Waiting time in our office? Extremely Dissatisfied	Waiting time in our office? Very Dissatisfied	Waiting time in our office? Somewhat Dissatisfied	Waiting time in our office? Satisfied	Waiting time in our office? Very Satisfied	Waiting time in our office? Extremely Satisfied
Ease in obtaining follow-up information and care (test results, medicines, care instructions)?	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Extremely Dissatisfied	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Very Dissatisfied	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Somewhat Dissatisfied	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Satisfied	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Very Satisfied	Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Extremely Satisfied
Overall medical care at your doctor’s office?	Overall medical care at your doctor’s office? Extremely Dissatisfied	Overall medical care at your doctor’s office? Very Dissatisfied	Overall medical care at your doctor’s office? Somewhat Dissatisfied	Overall medical care at your doctor’s office? Satisfied	Overall medical care at your doctor’s office? Very Satisfied	Overall medical care at your doctor’s office? Extremely Satisfied
Our office’s appearance?	Our office’s appearance? Extremely Dissatisfied	Our office’s appearance? Very Dissatisfied	Our office’s appearance? Somewhat Dissatisfied	Our office’s appearance? Satisfied	Our office’s appearance? Very Satisfied	Our office’s appearance? Extremely Satisfied
The way we teach you about improving your health?	The way we teach you about improving your health? Extremely Dissatisfied	The way we teach you about improving your health? Very Dissatisfied	The way we teach you about improving your health? Somewhat Dissatisfied	The way we teach you about improving your health? Satisfied	The way we teach you about improving your health? Very Satisfied	The way we teach you about improving your health? Extremely Satisfied
The way your doctor involves other doctors and caregivers in your care when needed?	The way your doctor involves other doctors and caregivers in your care when needed? Extremely Dissatisfied	The way your doctor involves other doctors and caregivers in your care when needed? Very Dissatisfied	The way your doctor involves other doctors and caregivers in your care when needed? Somewhat Dissatisfied	The way your doctor involves other doctors and caregivers in your care when needed? Satisfied	The way your doctor involves other doctors and caregivers in your care when needed? Very Satisfied	The way your doctor involves other doctors and caregivers in your care when needed? Extremely Satisfied

Extremely Dissatisfied

Very Dissatisfied

Somewhat Dissatisfied

Satisfied

Very Satisfied

Extremely Satisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments)

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Extremely Dissatisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Very Dissatisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Somewhat Dissatisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Satisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Very Satisfied

The ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments) Extremely Satisfied

Ease of making same-day/sick visit appointments?

Ease of making same-day/sick visit appointments? Extremely Dissatisfied

Ease of making same-day/sick visit appointments? Very Dissatisfied

Ease of making same-day/sick visit appointments? Somewhat Dissatisfied

Ease of making same-day/sick visit appointments? Satisfied

Ease of making same-day/sick visit appointments? Very Satisfied

Ease of making same-day/sick visit appointments? Extremely Satisfied

The time it takes someone from our office to respond when you call the office with an urgent problem?

The time it takes someone from our office to respond when you call the office with an urgent problem? Extremely Dissatisfied

The time it takes someone from our office to respond when you call the office with an urgent problem? Very Dissatisfied

The time it takes someone from our office to respond when you call the office with an urgent problem? Somewhat Dissatisfied

The time it takes someone from our office to respond when you call the office with an urgent problem? Satisfied

The time it takes someone from our office to respond when you call the office with an urgent problem? Very Satisfied

The time it takes someone from our office to respond when you call the office with an urgent problem? Extremely Satisfied

Waiting time in our office?

Waiting time in our office? Extremely Dissatisfied

Waiting time in our office? Very Dissatisfied

Waiting time in our office? Somewhat Dissatisfied

Waiting time in our office? Satisfied

Waiting time in our office? Very Satisfied

Waiting time in our office? Extremely Satisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)?

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Extremely Dissatisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Very Dissatisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Somewhat Dissatisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Satisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Very Satisfied

Ease in obtaining follow-up information and care (test results, medicines, care instructions)? Extremely Satisfied

Overall medical care at your doctor’s office?

Overall medical care at your doctor’s office? Extremely Dissatisfied

Overall medical care at your doctor’s office? Very Dissatisfied

Overall medical care at your doctor’s office? Somewhat Dissatisfied

Overall medical care at your doctor’s office? Satisfied

Overall medical care at your doctor’s office? Very Satisfied

Overall medical care at your doctor’s office? Extremely Satisfied

Our office’s appearance?

Our office’s appearance? Extremely Dissatisfied

Our office’s appearance? Very Dissatisfied

Our office’s appearance? Somewhat Dissatisfied

Our office’s appearance? Satisfied

Our office’s appearance? Very Satisfied

Our office’s appearance? Extremely Satisfied

The way we teach you about improving your health?

The way we teach you about improving your health? Extremely Dissatisfied

The way we teach you about improving your health? Very Dissatisfied

The way we teach you about improving your health? Somewhat Dissatisfied

The way we teach you about improving your health? Satisfied

The way we teach you about improving your health? Very Satisfied

The way we teach you about improving your health? Extremely Satisfied

The way your doctor involves other doctors and caregivers in your care when needed?

The way your doctor involves other doctors and caregivers in your care when needed? Extremely Dissatisfied

The way your doctor involves other doctors and caregivers in your care when needed? Very Dissatisfied

The way your doctor involves other doctors and caregivers in your care when needed? Somewhat Dissatisfied

The way your doctor involves other doctors and caregivers in your care when needed? Satisfied

The way your doctor involves other doctors and caregivers in your care when needed? Very Satisfied

The way your doctor involves other doctors and caregivers in your care when needed? Extremely Satisfied

	Extremely Dissatisfied	Very Dissatisfied	Somewhat Dissatisfied	Satisfied	Very Satisfied	Extremely Satisfied
Your doctor?	Your doctor? Extremely Dissatisfied	Your doctor? Very Dissatisfied	Your doctor? Somewhat Dissatisfied	Your doctor? Satisfied	Your doctor? Very Satisfied	Your doctor? Extremely Satisfied
Our medical staff (medical assistants, nurses, etc.)?	Our medical staff (medical assistants, nurses, etc.)? Extremely Dissatisfied	Our medical staff (medical assistants, nurses, etc.)? Very Dissatisfied	Our medical staff (medical assistants, nurses, etc.)? Somewhat Dissatisfied	Our medical staff (medical assistants, nurses, etc.)? Satisfied	Our medical staff (medical assistants, nurses, etc.)? Very Satisfied	Our medical staff (medical assistants, nurses, etc.)? Extremely Satisfied
Our front office staff?	Our front office staff? Extremely Dissatisfied	Our front office staff? Very Dissatisfied	Our front office staff? Somewhat Dissatisfied	Our front office staff? Satisfied	Our front office staff? Very Satisfied	Our front office staff? Extremely Satisfied

Extremely Dissatisfied

Very Dissatisfied

Somewhat Dissatisfied

Satisfied

Very Satisfied

Extremely Satisfied

Your doctor?

Your doctor? Extremely Dissatisfied

Your doctor? Very Dissatisfied

Your doctor? Somewhat Dissatisfied

Your doctor? Satisfied

Your doctor? Very Satisfied

Your doctor? Extremely Satisfied

Our medical staff (medical assistants, nurses, etc.)?

Our medical staff (medical assistants, nurses, etc.)? Extremely Dissatisfied

Our medical staff (medical assistants, nurses, etc.)? Very Dissatisfied

Our medical staff (medical assistants, nurses, etc.)? Somewhat Dissatisfied

Our medical staff (medical assistants, nurses, etc.)? Satisfied

Our medical staff (medical assistants, nurses, etc.)? Very Satisfied

Our medical staff (medical assistants, nurses, etc.)? Extremely Satisfied

Our front office staff?

Our front office staff? Extremely Dissatisfied

Our front office staff? Very Dissatisfied

Our front office staff? Somewhat Dissatisfied

Our front office staff? Satisfied

Our front office staff? Very Satisfied

Our front office staff? Extremely Satisfied

Question Title

* 3. Overall Satisfaction

	Yes	No	Maybe
Would your recommend Arroyo Vista Family Medicine to your family or friends?	Would your recommend Arroyo Vista Family Medicine to your family or friends? Yes	Would your recommend Arroyo Vista Family Medicine to your family or friends? No	Would your recommend Arroyo Vista Family Medicine to your family or friends? Maybe
Would your recommend Dr. Landero to your family or friends?	Would your recommend Dr. Landero to your family or friends? Yes	Would your recommend Dr. Landero to your family or friends? No	Would your recommend Dr. Landero to your family or friends? Maybe

Please offer any specific feedback here for any item(s) you answered No or Maybe to:

Question Title

* 4. At Arroyo Vista Family Medicine, we strive to continuously improve ourselves in an effort to improve quality of care and the overall patient experience. Please take a moment to give us specific feedback in areas we could grow in. Your feedback is greatly appreciated!

Question Title

* 5. OPTIONAL - IF you would like for us to get back to you regarding your answers on this survey, please provide us with your contact information below:

Name:

Best Contact Number:

Best Time(s) To Call:

Patient Feedback Survey - Arroyo Vista Family Medicine

Question Title

* 1. How satisfied are you with?:

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* 2. How caring would you say the following individuals are?:

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* 3. Overall Satisfaction

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* 4. At Arroyo Vista Family Medicine, we strive to continuously improve ourselves in an effort to improve quality of care and the overall patient experience. Please take a moment to give us specific feedback in areas we could grow in. Your feedback is greatly appreciated!

Question Title

* 5. OPTIONAL - IF you would like for us to get back to you regarding your answers on this survey, please provide us with your contact information below: