Patient Satisfaction Survey

To assist in our effort to provide you with the very best care, please take a few minutes to complete this survey. When you have completed your survey, please press the submit button at the bottom of this page. All of your answers and comments will be kept confidential.

Date:
/ /

Your Physician or Physician Assistant:

How would you rate your last visit?

Scheduling an Appointment

Ease of contacting the doctor's office by phone

Courtesy of the staff taking your call

Time it took to get an appointment that was convenient for you

Registration Process

Friendliness of the registration staff

Registration staff's ability to answer your questions in a way you could understand

Waiting Time

When you arrived in the reception area, how long did you wait before you saw the doctor?

Care you received from the nurses, technicians and medical assistants

Courtesy of the nurses/techs/medical assistants who treated you

Care you received from the physician or physician assistant

Courtesy of the health care provider who treated you

The health care provider's explanation of what was done for you (test, diagnosis, treatment)

10.

Confidence you felt in the health care provider's medical skills

Overall Rating

11. I would recommend the Rebound Center to my family and friends

Strongly Disagree

Somewhat Disagree

Neither Agree nor Disagree

Somewhat Agree

Strongly Agree

Please Tell Us

How can we improve our services to better meet your needs?

Follow Up (Optional)

Would you like to be contacted by a Rebound representative?
Yes No

If yes, please include your name and daytime phone number

Name

Daytime Phone Number

* Security Code:

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