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Doctor's Office Patient Satisfaction Survey
*1.
How likely is it that you would recommend our office to a friend or colleague?
Not at all likely Extremely likely
0 1 2 3 4 5 6 7 8 9 10
2.
Did your appointment with your provider start early, on time or late?
Very early
Somewhat early
On time
Somewhat late
Very late
3.
How would you rate the service you received from your provider?
4.
How easy was it to schedule your appointment?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
5.
How convenient is the location of our office?
Very convenient
Somewhat convenient
Neither convenient nor inconvenient
Somewhat inconvenient
Very inconvenient
6.
How convenient is the hours of our office?
Very convenient
Somewhat convenient
Neither convenient nor inconvenient
Somewhat inconvenient
Very inconvenient
7.
How comfortable was the lobby and waiting area?
Very comfortable
Somewhat comfortable
Neither comfortable nor uncomfortable
Somewhat uncomfortable
Very uncomfortable
8.
How satisfied were you with the front desk staff?
Extremely satisfied
Very satisfied
Somewhat satisfied
Not so satisfied
Not at all satisfied
9.
How satisfied were you with the amount of time your provider spent with you?
Extremely satisfied
Very satisfied
Somewhat satisfied
Not so satisfied
Not at all satisfied
10.
Do you have any other comments, questions, or concerns?
Thank you for taking this survey.
Thanks for your time! We're sorry you don't qualify for this survey.
 
 
Not at all likely Extremely likely
0 1 2 3 4 5 6 7 8 9 10
0 1 2 3 4 5 6 7 8 9 10
0 100
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