POST-VISIT PATIENT SATISFACTION SURVEY 1. You would recommend your provider to a friend or family member. Strongly Disagree Disagree Neutral Agree Strongly Agree 2. Overall, how satisfied or dissatisfied were you with your last visit to our office? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied 3. It was easy to schedule your appointment. Strongly Disagree Disagree Neutral Agree Strongly Agree 4. Overall, how would you rate the service you received from the staff at our office? Excellent Very good Good Fair Poor 5. Overall, how would you rate the care you received from your provider? Excellent Very good Good Fair Poor 6. Your provider listened to your needs. Strongly Disagree Disagree Neutral Agree Strongly Agree 7. Your provider answered your questions. Strongly Disagree Disagree Neutral Agree Strongly Agree 8. Your provider explained your treatment options? Strongly Disagree Disagree Neutral Agree Strongly Agree 9. Your provider explained your follow-up care well. Strongly Disagree Disagree Neutral Agree Strongly Agree 10. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied 11. Is there anything we could have done to improve your last visit? Thank you! Back to Patient Resources
