Patient Satisfaction Survey

We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this confidential survey.

 Just let us know what we are doing well and what we can to do better! Thank you.

Your physician/provider:

1.

Please indicate your level of satisfaction with the following items related to your office appointment. Use a scale of 1 to 5, with 5 being Very Satisfied and 1 being Not at all Satisfied. If an item is not related to your care, choose N/A.
Getting through to the office by phone.
The time between your call to schedule an appointment and your appointment date.
The manners of the person'(s) who scheduled your appointment.
Clarity of directions to the office and the time of your appointment.
The professionalism and helpfulness of your reception.
Your wait time in the office.
The comfort, cleanliness and amenities of the reception area.
The extent to which staff respected your privacy.

2.

Please rate the following items related to the delivery of your care. Use a scale of 1 to 5, with 5 being Excellent and 1 being Poor. If an item is not related to your care, choose N/A.
You physician/provider’s listening skills.
His or her explanation of procedures, diagnoses or treatment regimen.
His/her personal manner (courtesy, respect, sensitivity, friendliness).
Other staff’s personal manner (courtesy, respect, sensitivity, friendliness).
Technical skills (thoroughness, carefulness, competence) of the physician/practitioner.
How prepared (records and educational materials readily available) the staff and physician/provider were for your visit.

3.

Please indicate the extent to which you agree or disagree with each of the following statements. Use a scale of 1 to 5, with 5 being Strongly Agree and 1 being Strongly Disagree. If an item is not related to your care, choose N/A.
My physician/provider spent adequate time with me.
The service/care provided was valuable to improving my health.
The educational information I received was helpful.
I clearly understand the next steps in my plan of care.

4.

If lab work was done, did you receive your lab results in a timely manner following your office visit?

5.

Would you return to see this physician/practitioner for further care?

6.

Would you recommend this practice to family and friends?

7.

Did any specific staff member stand out?
If Yes who and why?

8.

Was there any aspect of your care that could be improved?
If Yes Please Explain.

9.

How did you hear about Dr. Taleghani? 
10. Who is your referring physician?

 
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