Patient Satisfaction Questionnaire | Neurology Clinic P.C.

Call

Patient Satisfaction Questionnaire

Patient-Centered, Evidence-Based Neurological Care

1

	Poor	Fair	Good	Very Good	Excellent
How would you rate overall level of customer service provided by our clinic staff during your visit?	PoorHow would you rate overall level of customer service provided by our clinic staff during your visit? Poor	FairHow would you rate overall level of customer service provided by our clinic staff during your visit? Fair	GoodHow would you rate overall level of customer service provided by our clinic staff during your visit? Good	Very GoodHow would you rate overall level of customer service provided by our clinic staff during your visit? Very Good	ExcellentHow would you rate overall level of customer service provided by our clinic staff during your visit? Excellent

2

	Not at all	Somewhat	Moderately	Mostly	Completely
How satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit?	Not at allHow satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit? Not at all	SomewhatHow satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit? Somewhat	ModeratelyHow satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit? Moderately	MostlyHow satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit? Mostly	CompletelyHow satisfied were you with the professionalism, responsiveness, and overall support provided by the medical assistant during your visit? Completely

3

	Not at all	Somewhat	Moderately	Mostly	Completely
Did your healthcare provider listen to your concerns and answer your questions?	Not at allDid your healthcare provider listen to your concerns and answer your questions? Not at all	SomewhatDid your healthcare provider listen to your concerns and answer your questions? Somewhat	ModeratelyDid your healthcare provider listen to your concerns and answer your questions? Moderately	MostlyDid your healthcare provider listen to your concerns and answer your questions? Mostly	CompletelyDid your healthcare provider listen to your concerns and answer your questions? Completely

have 14 3

4

	Not at all	Somewhat	Moderately	Mostly	Completely
Did your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand?	Not at allDid your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand? Not at all	SomewhatDid your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand? Somewhat	ModeratelyDid your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand? Moderately	MostlyDid your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand? Mostly	CompletelyDid your healthcare provider explain your diagnosis and treatment options in a way that was easy to understand? Completely

5

	Not at all	Somewhat	Moderately	Mostly	Completely
Did you feel that you had enough time to discuss your concerns with your healthcare provider?	Not at allDid you feel that you had enough time to discuss your concerns with your healthcare provider? Not at all	SomewhatDid you feel that you had enough time to discuss your concerns with your healthcare provider? Somewhat	ModeratelyDid you feel that you had enough time to discuss your concerns with your healthcare provider? Moderately	MostlyDid you feel that you had enough time to discuss your concerns with your healthcare provider? Mostly	CompletelyDid you feel that you had enough time to discuss your concerns with your healthcare provider? Completely

6

	Not at all	Somewhat	Moderately	Mostly	Completely
Were you provided with clear instructions on how to manage your condition at home?	Not at allWere you provided with clear instructions on how to manage your condition at home? Not at all	SomewhatWere you provided with clear instructions on how to manage your condition at home? Somewhat	ModeratelyWere you provided with clear instructions on how to manage your condition at home? Moderately	MostlyWere you provided with clear instructions on how to manage your condition at home? Mostly	CompletelyWere you provided with clear instructions on how to manage your condition at home? Completely

7

	Not at all	Somewhat	Moderately	Mostly	Completely
How would you rate your level of involvement in decisions regarding your care?	Not at allHow would you rate your level of involvement in decisions regarding your care? Not at all	SomewhatHow would you rate your level of involvement in decisions regarding your care? Somewhat	ModeratelyHow would you rate your level of involvement in decisions regarding your care? Moderately	MostlyHow would you rate your level of involvement in decisions regarding your care? Mostly	CompletelyHow would you rate your level of involvement in decisions regarding your care? Completely

8

	Not at all	Somewhat	Moderately	Mostly	Completely
How easy was it to contact the clinic by phone and schedule an appointment?	Not at allHow easy was it to contact the clinic by phone and schedule an appointment? Not at all	SomewhatHow easy was it to contact the clinic by phone and schedule an appointment? Somewhat	ModeratelyHow easy was it to contact the clinic by phone and schedule an appointment? Moderately	MostlyHow easy was it to contact the clinic by phone and schedule an appointment? Mostly	CompletelyHow easy was it to contact the clinic by phone and schedule an appointment? Completely

9

	Not at all	Somewhat	Moderately	Mostly	Completely
Were you seen by your healthcare provider within a reasonable amount of time?	Not at allWere you seen by your healthcare provider within a reasonable amount of time? Not at all	SomewhatWere you seen by your healthcare provider within a reasonable amount of time? Somewhat	ModeratelyWere you seen by your healthcare provider within a reasonable amount of time? Moderately	MostlyWere you seen by your healthcare provider within a reasonable amount of time? Mostly	CompletelyWere you seen by your healthcare provider within a reasonable amount of time? Completely

10

	Not at all	Somewhat	Moderately	Mostly	Completely
How satisfied are you with response time to calls/messages?	Not at allHow satisfied are you with response time to calls/messages? Not at all	SomewhatHow satisfied are you with response time to calls/messages? Somewhat	ModeratelyHow satisfied are you with response time to calls/messages? Moderately	MostlyHow satisfied are you with response time to calls/messages? Mostly	CompletelyHow satisfied are you with response time to calls/messages? Completely

11

	Not at all	Somewhat	Moderately	Mostly	Completely
Were you provided with referrals to other healthcare professionals or resources as needed?	Not at allWere you provided with referrals to other healthcare professionals or resources as needed? Not at all	SomewhatWere you provided with referrals to other healthcare professionals or resources as needed? Somewhat	ModeratelyWere you provided with referrals to other healthcare professionals or resources as needed? Moderately	MostlyWere you provided with referrals to other healthcare professionals or resources as needed? Mostly	CompletelyWere you provided with referrals to other healthcare professionals or resources as needed? Completely

12

	Not at all	Somewhat	Moderately	Mostly	Completely
How would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)?	Not at allHow would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)? Not at all	SomewhatHow would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)? Somewhat	ModeratelyHow would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)? Moderately	MostlyHow would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)? Mostly	CompletelyHow would you rate the cleanliness, comfort, and overall adequacy of our clinic facilities (waiting areas, exam rooms, restrooms, and other common areas)? Completely

13

	Very poor	Poor	Good	Very Good	Excellent
How would you rate your experience with the organization?	Very poorHow would you rate your experience with the organization? Very poor	PoorHow would you rate your experience with the organization? Poor	GoodHow would you rate your experience with the organization? Good	Very GoodHow would you rate your experience with the organization? Very Good	ExcellentHow would you rate your experience with the organization? Excellent

14

	Not Likely	Neutral	Likely	Very Likely	Extremely likely
How likely are you to refer our clinic to your family, friends, and others seeking neurological medical care?	Not LikelyHow likely are you to refer our clinic to your family, friends, and others seeking neurological medical care? Not Likely	NeutralHow likely are you to refer our clinic to your family, friends, and others seeking neurological medical care? Neutral	LikelyHow likely are you to refer our clinic to your family, friends, and others seeking neurological medical care? Likely	Very LikelyHow likely are you to refer our clinic to your family, friends, and others seeking neurological medical care? Very Likely	Extremely likelyHow likely are you to refer our clinic to your family, friends, and others seeking neurological medical care? Extremely likely

Do you have any suggestions for how our organization can improve its services?