Physician Office Patient Satisfaction Survey

What type of doctor's office did you most recently visit?

Primary Care

Walk In Clinic

Specialist : Type: _________________

Were you greeted courteously when you arrived?

yes

no

don't remember

Was the office running on time?

Yes

No

Given the following choices, how would you describe the waiting area ?

Excellent: It was clean, had comfortable chairs, t.v. and reading materials

Good: There was seating, a few extras

Fair: There was seating but not very inviting.

Poor: I would rather wait in my car.

Approximately how long did you wait in the reception area before being called in to see the doctor?

1-5 minutes

6-10 minutes

more than 15 minutes

If you waited more than 15 minutes, did the receptionist keep you informed about the expected wait time?

Weekly

Monthly

Quarterly

Annually

Did you feel that this office valued your time?

Yes

No

Would you refer friends or family to this particular facility?

Yes

No