Patient Satisfaction Survey

At Emmaus Med-Surg Clinic, we strive to offer our patients the best care and courtesy possible. In order to achieve this, we would greatly appreciate your feedback on your experience at our office.

Please take a few minutes to fill out this survey on the timeliness and quality of the service you received at your most recent visit. Emmaus Med-Surg Clinic welcomes your feedback, and your answers will be kept confidential. Thank you for your participat
General Patient Information
_ In general, what is the quality of your health?
_ How would you rate our concern for your privacy?
_ How often have you visited Emmaus Med-Surg Clinic within the last year?
Scheduling Your Appointment
_ Did you schedule an appointment by phone or did you drop in?
_ If you scheduled an appointment, did you have to wait longer than expected to get scheduled?
_ How easy was it to make an appointment by phone, 1 being easy and 5 being very difficult?
_ How long did you wait to a scheduling staff member?
_ On a scale of 1-5 with one being very courteous, was the person who scheduled your appointment courteous and helpful?
_ If you were seeking a referral to a specialist, was your request handled in a timely manner?
Day of Your Appointment
_ On a scale of 1-5 with 1 being very courteous, how would you rate the courtesy of the staff at the reception desk?
_ How long did you wait in the reception area beyond your scheduled appointment time?
_ How long did you wait in the exam room before the physician appeared?
The Nursing Staff
_ How would you rate the competence of the nurse who helped you?
_ How would you characterize the concern that the nurse showed for your problem?
_ Did the nurse respond to your requests within a reasonable period?
The Doctor
_ Did you feel that your doctor spent an adequate amount of time with you?
_ Please select the attributes that characterize the demanor of your doctor?
_ Did you feel that your doctor's exam was thorough?
_ Please rate the clarity of the doctor's explanation of your condition and treatment options
_ How would you rate the competence of your doctor?
_ How well did your doctor include you in healthcare decisions?
_ Were your questions answered to your satisfaction?
_ Would you recommend this facility and its staff to your family and friends?
Additional Feedback
_ Please list any areas in which our service could be improved.
_ Please list any additional comments.
Personal Information - Providing the following information is optional.
_ Name
_ Address
_ Phone Number
_ Gender
_ Age
_ Would you like someone to contact you regarding your responses on this survey?
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Thank you for taking the time to fill out our survey. We rely on your feedback to help us improve our services. Your input is greatly appreciated.

Patient Satisfaction Survey

At Emmaus Med-Surg Clinic, we strive to offer our patients the best care and courtesy possible. In order to achieve this, we would greatly appreciate your feedback on your experience at our office.

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