Title Page
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Clinic branch
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Conducted on
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Prepared by
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Location
Patient Satisfaction Questionnaire
Patient Satisfaction
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How long have you been a patient here?
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If this is your first visit, how did you hear about us?
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Other:
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How convenient are we in the following areas?
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• Location
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• Parking
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• Clinic hours
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• Availability of staff to help you with your questions
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Please let us know what we can do to improve any of these areas.
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Was it easy and convenient to get an appointment?
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When you last contacted the clinic by phone, were you treated courteously by the staff?
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When making your last appointment, did the staff make every effort to suggest a time and day that was convenient for you?
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When you come into the clinic, is the staff courteous?
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Are you usually seen in a prompt manner?
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Please rate us on how genuinely interested we seem to be in you as a person.
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During your visits, do you think we adequately answer your questions?
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Are you satisfied with the quality of medical treatment you receive from us?
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On a scale of 1 to 5, 1 being extremely poor and 5 being excellent, how would you rate your overall experience with our clinic?
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What could we do to make the experience better?
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If there was one thing you could change about your experience with this clinic, what would it be?
