1. Did you find our office location convenient and easily accessible?
Yes
No
2. What's more important to you, the physical location of your Ob/Gyn or your "relationship" with her/him?
Location
Relationship
3. Were you greeted promptly and courteously upon arrival?
Yes
No
4. Were our billing and insurance policies made clear to you?
Yes
No
5. Was the waiting time in the reception area before being brought to the examining room acceptable?
Yes
No
6. Was the waiting time in the examining room before the doctor/nurse practitioner saw you acceptable?
Yes
No
7. Did the doctor/nurse practitioner take enough time to listen to everything you had to say and ask?
Yes
No
8. Did the doctor/nurse practitioner thoroughly explain the diagnosis and clearly explain instructions for follow-up care?
Yes
No
9. Have you had any problems reaching the office after hours or on weekends?
Yes
No
10. If a friend were looking for an Ob/Gyn, would you recommend our practice to her?
Yes
No
11. If you answered "NO" to any of the preceeding questions, please briefly explain the reasons for your answer(s):
On a scale of 1 to 5 with 5 signifying the highest degree of satisfaction and 1 the lowest, how would you rate your satisfaction with the following aspects of our practice?
12. Front office staff
1
2
3
4
5
13. Nurse Practitioner
1
2
3
4
5
14. Our billing and insurance policies
1
2
3
4
5
15. Our scheduling and punctuality with appointments
1
2
3
4
5
16. The attention and care you received from our doctor
1
2
3
4
5
17. Your ability to reach us by phone
1
2
3
4
5
18. Convenience of current office hours compared to your schedule
1
2
3
4
5
19. Which person did you see at your last visit?
20. If you could change one thing about our practice, what would it be and how would you change it?
Copyright 2001 Complete & Compassionate OB/GYN Care, P.A.
