Please rate the following experiences related to our staff and our facility in terms of our performance and your comfort during your evaluation and or surgical visit.
Your Scheduling & Telephone Experience
1
2
3
4
5
N/A
1) The overall scheduling ease
2) Time spent on hold in order to schedule appointment
3) Efficiency of scheduler in gathering necessary information
4) If you left a message, your call was promptly returned by staff
5) Handled call in a courteous manner
6) Scheduler's introduction and orientation to our website for online patient registration
7) Ease of our online patient registration
8) Use of the automated appointment confirmation
Your Waiting Room Experience
1
2
3
4
5
N/A
9) Greeted warmly upon arrival
10) Speed of check-in process
11) Concern for your privacy of information
12) Time spent in waiting room prior to back office seating
13) Comfort of our waiting room
14) Reading materials
Doctor Delays, if any
1
2
3
4
5
N/A
15) Acknowledgement of doctor delays
16) How well did we keep you informed of doctor delays
17) Response time of back office surgical assistant to your comfort and care during doctor delays, beginning from within our waiting room
18) Time spent in exam or treatment room waiting for the doctor
Your Back Office Experience
1
2
3
4
5
N/A
19) Friendly and courteous
20) Appeared professional and technically competent
21) Explained all procedures and gave clear instructions
22) Concern for your needs
23) Concern for your privacy
24) Music
Your Doctor Experience
1
2
3
4
5
N/A
25) Appeared genuinely concerned about you
26) Explained findings and treatment plan
27) Encouraged and answered your questions
28) Spent an adequate amount of time with you
Your Treatment Planning Experience
1
2
3
4
5
N/A
29) Friendly and courteous
30) Explained financial responsibility and how it applies to your treatment plan in a clear manner
31) Helped to prepare you for the scheduling of your treatment
32) Offered take home educational materials related to your proposed treatment
Your Billing Experience
1
2
3
4
5
N/A
33) Clarity of Patient Financial Agreement
34) Understanding of financial obligation prior to the performance of services
35) Written explanation of services performed at the check out desk
36) Perception of value towards services performed
37) Processing your insurance claim
38) Outside finance services
Educational Materials
1
2
3
4
5
N/A
39) Website
40) Brochures and leaflets
41) DVD/Audiovisual
42) Informed consents
43) Treatment Plan
Your Follow up Experiences
1
2
3
4
5
N/A
44) Response time to your questions by telephone during normal business hours.
45) Responsiveness and follow up of after hour calls.
46) Response time to voice messages.
47) Response time to e-mail messages.
Your Overall Experience
1
2
3
4
5
N/A
48) Your Satisfaction
49) Attitude of our staff
50) Organization and cleanliness
51) Preparation for home care after surgery
Your Profile
52) Were you worked in to see the doctor or did you call in advance to schedule your appointment?
Select...
Work-in
Scheduled in advance
53) When calling to schedule an appointment, how many days elapsed before you were scheduled to see the doctor?
Select...
Same day
1-2 days
3-4 days
5-6 days
more than 7 days
54) What type of appointment did you have?
Select...
Exam
X-ray only
Impression
Surgery
Follow-up
55) Further comments or suggestions (all comments, whether positive or negative are appreciated) In addition, we recognize employees who exceed patient expectations in providing quality service. If there are employees that merit special recognition, please provide their names.
