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Patient Experience Survey

The physicians and staff want your feedback!
Please answer the following questions that will contribute to the continued improvement of our services.
The survey is confidential. Please DO NOT add your name.


Age
Under 18  18-30  31-40  41-50  51-60  61-70  70+  
Gender
Female  Male  Other/Undeclared  
The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office?
Same Day  
Next Day  
2 - 10 Days  
11 - 20 Days  
More than 20 Days  
Not applicable (don 't know/refused)  
After your scheduled time, on average, how long do you wait for your appointment? (Includes time spent in the waiting room and exam room).
Immediately  
Less than 5 minutes  
5 to 15 minutes  
15 to 30 minutes  
30 to 60 minutes  
Over 60 minutes  
When making an appointment, is the Receptionist courteous and helpful?
                 
Do you feel that the appointment offered to you was within a reasonable amount of time?
                 
When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about the recommended treatment?
                 
When you see your doctor or nurse practitioner, how often do they or someone else in the office spend enough time with you?
                 
How often are you able to reach us by telephone?
                 
The Staff treat you in a respectful and confidential manner?
                 
Please share any additional comments.