Patient Satisfaction Sample Survey


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DoctorCare HealthCare Physicians

Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving these services.  

Your Privacy is Protected. All information that would let someone identify your or your family will be kept private. OutSource Services, Inc. will not share your personal information with anyone without your OK. Your responses to this survey are also completely confidential.

Your Participation is Voluntary. You may choose to answer this survey or not. If you choose not to, this will not affect the health care you get.

What To Do When You're Done. Once you complete the survey, click the "Complete Survey" button.



Survey Instructions

Answer each question by clicking the appropriate answer.

Click "Continue" at the bottom of each page.

Click "Complete Survey" at the end of the survey.

Ease of getting care:
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Ability to get in to be seen
Hours Center is open
Convenience of Center's location
Prompt return on calls
Waiting
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results
Staff: Provider: (Physician, Dentist, Physician Assistant, Nurse Practitioner)
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Listens to you
Takes enough time with you
Explains what you want to know
Gives you good advice and treatment
Nurses and Medical Assistants:
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Friendly and helpful to you
Answers your questions
All Others:
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Friendly and helpful to you
Answers your questions
Payment:
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
What you pay
Explanation of charges
Collection of payment / money
Facility:
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Neat and clean building
Ease of finding where to go
Comfort and Safety while waiting
Privacy
Confidentiality
 

5-Great
4-Good
3-OK
2-Fair
1-Poor
Keeping my personal information private

The likelihood of referring your friends and relatives to us:

5-Great
4-Good
3-OK
2-Fair
1-Poor

Do you consider this center your regular source of care?



What do you like best about our center?

What do you like least about our center?

Suggestions for improvement.

Thank you for completing our Survey!
Please click "Complete Survey" below. You will return to survey1online.com.