Patient Satisfaction Survey Thank you for your feedback!Instructions We would like to know how you feel about the services we provide so that we can make sure we are meeting your needs. All responses will be kept confidential and anonymous. Thank you!Age1. Age Under 1818-3031-4546-6061+Gender2. Gender MaleFemaleInstructions Please rate your experience in the following areas:Ease of getting careAbility to get in to be seen ExcellentGoodFairPoorN/AHours office is open ExcellentGoodFairPoorN/AConvenience of office location ExcellentGoodFairPoorN/APrompt retun of phone calls ExcellentGoodFairPoorN/AComments: WaitingTime in waiting room ExcellentGoodFairPoorN/ATime in exam room ExcellentGoodFairPoorN/AWaiting for tests to be performed ExcellentGoodFairPoorN/AWaiting for test results ExcellentGoodFairPoorN/AComments: ProviderWhich Health Care Provider did you see? Chose providerDr. Randall Norris, MDDr. Brian Blessinger, MDDr. Brian Woebkenberg, MDWilliam Walker, NPKelsey Vonderheide, PA-CJarred Lampert, PA-CProvider evaluationRate your experience with your provider and staff: Listens to you ExcellentGoodFairPoorN/ATakes enough time with you ExcellentGoodFairPoorN/AExplains what you want to know ExcellentGoodFairPoorN/AGives you good advise and treatment ExcellentGoodFairPoorN/AFriendly and helpful to you ExcellentGoodFairPoorN/AAnswers your questions ExcellentGoodFairPoorN/ANurses and Medical Assistants ExcellentGoodFairPoorN/AComments: All other office staffFriendly and helpful to you ExcellentGoodFairPoorN/AAnswers your questions ExcellentGoodFairPoorN/AComments: Charges & BillingCost of services ExcellentGoodFairPoorN/AExplanation of charges ExcellentGoodFairPoorN/ACollection of payment/money ExcellentGoodFairPoorN/AComments: FacilityNeat and clean building & office ExcellentGoodFairPoorN/AEase of finding where to go ExcellentGoodFairPoorN/AComfort and Safety while waiting ExcellentGoodFairPoorN/APrivacy ExcellentGoodFairPoorN/AComments: Would you refer us to your friends or family? YesMaybeNoWhat do you like best about our office? What do you like least about our office? Do you have any suggestions for improvement? VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
