Patient Satisfaction Survey

We Value Your Opinion

The physicians and staff of 1960 Family Practice value your opinion. Our goal is to provide excellent care and customer service. Would you please take a moment and answer the following questions? Please utilize this form to express any concerns, criticisms or comments you may have about an area or person in our office. Thank you for your cooperation and assistance.

Your appointment today is with*

Length of time waiting at office to see doctor

Number of minutes waited

Cleanliness of Office

Courtesy/Friendliness shown to you by the appointment staff

Courtesy/Friendliness shown to you by the check-in staff

Courtesy/Friendliness shown to you by the check-out staff

Courtesy/Friendliness shown to you by the medical staff

Courtesy/Friendliness shown to you by the lab technician

Courtesy/Friendliness shown to you by the X-Ray technician

Courtesy/Friendliness shown to you by the billing staff

Explanation and resolution to billing questions

Courtesy/Friendliness shown to you by the physician

Thoroughness of doctor's examination and evaluation

Explanation about test results, procedures and treatment plan

Overall quality of care and service by the physician

Accessibility of office by phone

Accessibility of nursing staff by phone during office hours

Length of time waiting for returned call by medical staff

The probability you would recommend 1960 Family Practice

Overall satisfaction of visit

Would you use the website for any of the following?

Billing Inquiries

Medical Questions

Appointments

Prescription Refills

Referrals

Patient Satisfaction Survey

Patient Satisfaction Survey

We Value Your Opinion

Would you use the website for any of the following?

Locations

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