Patient Satisfaction Survey

Our goal is to provide V.I.P., Very Important Patient, medical care to patients of all ages in a relaxed, comforting setting. Our patients receive the most modern medical care available today in an old fashioned manner.

We would like to know how you feel about the services we provide so that we can not only be certain we are meeting your needs but also improve upon our services.

All responses will be kept confidential. You may choose to remain anonymous. If you would like to remain anonymous in the field requiring your name please enter "anonymous" and in the following field requiring your email address please enter anonymous@email.com.

Thank you for allowing us to provide medical care to you and for taking the time and effort to complete this form so that we can continue to get better.

Dr. H. Mones
Cynthia Freites PA
and Staff

* Required fields
Name *
E-mail Address *
If you called our office to schedule your appointment, was your call answered promptly after a reasonable amount of rings?	Very promptly, few rings After a reasonable number of rings Rang many, many times before answered N/A, I scheduled my appointment on-line
If you called our office to schedule your appointment, were you placed on hold?	I was not placed on hold For a short time For a reasonable amount of time For an excessive amount of time N/A, I scheduled my appointment on-line
If you called our office to schedule your appointment, please rate the person that answered your call.	Excellent Good Fair Poor N/A, I scheduled my appointment on-line.
If you scheduled your appointment on-line, did you find our on-line appointment scheduler user friendly and helpful?	Yes, quite helpful No, not helpful. N/A, I called in to arrange my appointment.
Was our reception area neat, clean and comfortable?	Yes No
Did you find our magazine selection current and adequate for your interests?	Yes No
Did our office make it convenient for you to get in to be seen?	Yes No
Because our office does our very best to accommodate both new and established patients with same day visits when they are ill, we do understand that at times the wait is longer than all of us would like. Are you satisfied with the time you waited in the reception area?	Yes No
Were you greeted professionally and courteously by the medical assistant who escorted you from the reception area?	Yes No
Once in the Exam room, were you treated professionally, courteously and sympathetically by the medical assistant?	Yes No
After you were escorted into the exam room, were you satisfied with the amount of time you waited before the doctor or physician assistant attended to your concerns?	Yes No
Did the doctor or physician assistant listen attentively to your concerns?	Yes No
Did the doctor or physician assistant spend enough time with you?	Yes No
Did the doctor or physician assistant take the time to answer all your questions?	Yes No
Were you happy with the advice and treatment given to you by the doctor or physician assistant?	Yes No
Your opinions, concerns and suggestions are very important to us and will help us improve upon your care. Please feel free to be open and honest with any additional comments or suggestions so that we can do everything possible to be the best we can be.

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