PatientSatisfaction

 

Name *

Provider Seen *

I am between the ages of *

Did you feel that you were able to schedule an appointment in a reasonable time-frame from the time you contacted your provider's office? *

Did you feel the office staff was friendly, available and willing to answer any questions or concerns? *

Did you feel that you received clear instructions or information on your condition or health? *

Are you comfortable with your treatment plan? *

Do you know how to receive car or clinical advice from PPCP after-hours and on weekends? *

Do you feel confident in your ability to provide self-care and manage your condition and health? *

Do you feel you have access to your provider or members of the medical staff if you had any questions or concerns? *

If you were referred to another provider or had a lab or other medical test done, do you feel the appointment was scheduled or the results of your test were communicated in a timely manner? *

Comments: (Please do not include any personal medical information, for medical questions please contact your doctor's office directly.) *