Survey Templates Health Care Surveys Medical Examination Services Survey Template

Medical Examination Services Survey Template

The Medical Examination Services Survey collects feedback on a patients' overall experience with their current medical services provider. Additionally, it collects data on what would they consider important in any medical examination services provider. The sample template has questions on the staff members involved, speed, efficiency, cleanliness, and comfort of the facility.

Use the survey results to improve your services and formulate a business strategy. This free survey template is ready to be used in your research. You can also customize it as per your needs.

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The following set of questions are about with the medical examination services performed during routine examinations. Please rate the level of importance for each service.

	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure
Speed in completing examinations	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Accuracy and completeness in filling out report	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Expertise of medical staff	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Medical representative treatment	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Services offered for examination	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Delivery of reports to insurance office	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Personal relationship	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure
Information received	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Effort to make you feel comfortable	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Friendliness of staff	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

Cleanliness	Not At All Satisfied	Somewhat Satisfied	Neutral	Somewhat Satisfied	Very Satisfied	Not applicable/ Not sure

If a medical examination service were to guarantee:

(A)    Professionalism in the medical staff

(B)    Accurately filled out and completed reports

(C)    A completed report back to you within 3 days

Would you permanently change to this agency?

Yes

Not sure

How would you rate on each of the following items with your current medical service provider?

	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure
Speed in completing examinations	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Accuracy and completeness in filling out report	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Expertise of medical staff	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Medical representative treatment	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Services offered for examination	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Delivery of reports to insurance office	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Personal relationship	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure
Information received	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Effort to make you feel comfortable	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Friendliness of staff	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

Cleanliness	Excellent	Very Good	Good	Fair	Poor	Not applicable/ Not sure

use this free template

Medical Examination Services Survey Template

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