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Patient Satisfaction Survey

Clinic*:       Provider*:   

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Dear Member,
We are continually striving to improve our services to make your healthcare experience more satisfying. Please take a few moments to answer the following questions. Your answers will remain anonymous unless you choose to identify yourself.

Please be aware that any personally identifiable information you submit may be intercepted against our will by third parties and that any information pertaining to your medical care is transmitted here at your own risk. Please do not use this survey to contact your physician for medical questions. Also, please do not include confidential medical information in the text of the survey. We prefer that you contact your Primary Care Physician via telephone rather than through this survey for questions of a medical or confidential nature.

Thank you for participating.

 

Scheduling Your Appointment Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
Your phone calls are usually answered promptly. 1
2
3
4
5
Our receptionist is always friendly and helpful. 1
2
3
4
5
You can schedule a convenient / timely appointment with your physician. 1
2
3
4
5
Our hours of operation are convenient for you. 1
2
3
4
5
Your physician answers your calls promptly. 1
2
3
4
5

 

Your Appointment Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
You usually wait less than 20 minutes to see your physician. 1
2
3
4
5
Your physician's nurse is always helpful and courteous. 1
2
3
4
5
Your physician is always professional and courteous. 1
2
3
4
5
Your physician listens to all of your concerns. 1
2
3
4
5
Your physician answers all of your questions. 1
2
3
4
5
Your physician adequately explains any tests or treatment options. 1
2
3
4
5
You are able to make a convenient / timely appointment for follow-up care. 1
2
3
4
5
You usually receive your test results in a timely manner. 1
2
3
4
5

 

Facilities
Was the office clean? Yes No
Were the examining rooms clean? Yes No
Were the restrooms clean? Yes No

 

Operations
Have you ever visited a Pioneer Medical Group after-hours clinic?

Yes No
Have you attended a class or informational seminar hosted by Pioneer Medical Group?

Yes No
Would you refer your friend to a physician at Pioneer Medical Group?

Yes No
If no, please explain:   
Additional Comments:
Your Name (Optional)
Your Email (Optional)
Telephone number if you would like a follow-up call to discuss your concerns:  

Corporate Address: 17777 Center Court Drive, Suite 400, Cerritos, CA 90703.  Phone: 562-229-9452  Fax: -562-229-0952.
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