Patient Portal

Survey

Name (Optional)
First Last
MD/PA you saw today*
Thank you for your recent visit to our office. We would like to hear from you so that we can ensure you are having the best experience possible with our office. Please take a minute to fill out this survey. All responses are confidential. Thank you.
Was the time between your call to schedule an appointment and your appointment date reasonable?
1 2 3 4 5
Comments
Did you get to see the provider you requested when you called to schedule an appointment?
1 2 3 4 5
Comments
Was our phone staff helpful and congenial?
1 2 3 4 5
Comments
How are the hold times you experience when calling the office?
1 2 3 4 5
Comments
The professionalism and helpfulness of the front desk staff?
1 2 3 4 5
Comments
Was your wait time in the office acceptable?
1 2 3 4 5
Comments
Did your physician/PA spend an appropriate amount of time with you?
1 2 3 4 5
Comments
Was your wait time in the exam room reasonable?
1 2 3 4 5
Comments
Did the PA/MD explain procedures, diagnoses, and treatment plan?
1 2 3 4 5
Comments
How do you feel about the PA/MD’s “bedside manner”?
1 2 3 4 5
Comments
Did you feel that your concerns/issues were addressed adequately?
1 2 3 4 5
Comments
Was your nurse professional and courteous?
1 2 3 4 5
Comments
If the nurse performed any procedure such as drawing blood, EKG, ear cleansing, respiratory therapy, immunization or injection, did she seem knowledgeable and complete the procedure in a professional manner?
1 2 3 4 5
Comments
Were you provided tools or resources to help you better manage the care of any chronic diseases such as high blood pressure, high cholesterol or diabetes? Examples (Diets, referral for diabetic instruction, blood sugar logs, blood pressure logs, online resources)
1 2 3 4 5
Comments

If you have visited our practice before, how were your experiences with:

	1	2	3	4	5
Prescription refills (if appropriate)
Notification of Lab results (if appropriate)
Referral for testing or specialty appointments(if appropriate)
Lab Services (appointments scheduled in the lab only)
Nursing Services(appointments scheduled with a nurse only)

Comments
If you use the online patient portal, does it offer added convenience? Do you like having this service available?
Any comments or suggestions for our practice not addressed above: