Survey – Midwest Digestive Center

PATIENT SATISFACTION SURVEY

Please take a few minutes to help us evaluate our medical practice. This is important to us because we are interested in providing you with the finest quality, & the most comprehensive medical services.

If you mark any answers negatively, we would especially appreciate additional comments regarding your concerns. All responses are anonymous, so please take this opportunity to respond freely.

New Patient
Returning Patient

1.What factors influenced your initial choice in selecting our office :

Referred by another Patient
Referred by a Physician
Referred by family member or friend
Member of HMO, PPO or other managed care plan
Telephone listings or online research
Other
Close to home / business

Please specify

2.Where your phone calls handled courteously and in a professional manner?

Yes
No

3.Where you able to make appointment easily & within a reasonable time period ?

Yes
No

4. When you called for appointment, was the office staff helpful & courteous?

Yes
No

5. Did you find the reception area pleasant and comfortable?

Yes
No

6. Did the physician answer all your questions?

Yes
No

7. Did the physician spend enough time with you?

Yes
No

8. Did you find the examining room clean and comfortable ?

Yes
No

9. Where you able to schedule your next visit at your convenience ?

Yes
No

10. Did we provide adequate review or instructions after you saw the doctor?

Yes
No

Appointment wait time:

:

Comments /Suggestions to improve our service