Patient Satisfaction Survey

We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this survey. All responses are confidential, and we don’t want you to sign it or otherwise indicate your name. Just let us know what to do better!

Thank you.

On a scale from 1 to 5, with 5 being excellent and 1 being poor, how would you rate:



1. The time between your call to schedule an appointment and your appointment date? Did we fit you in fast enough?
 1 2 3 4 5

Comments:
poor excellent


 
2. The time it took us to answer your call?
 1 2 3 4 5

Comments:
poor excellent


 
3. The manners of the person(s) who scheduled your appointment?
 1 2 3 4 5

Comments:
poor excellent


 
4. The convenience of our location?
 1 2 3 4 5

Comments:
poor excellent



 
5. Parking convenience? 1 2 3 4 5

Comments:
poor excellent


 
6. The professionalism and helpfulness of your reception. Was the receptionist polite? Were your questions answered? 1 2 3 4 5

Comments:
poor excellent


 
7. Your wait time in the office? 1 2 3 4 5

Comments:
poor excellent


 
8. The comfort, cleanliness and amenities of the reception? 1 2 3 4 5

Comments:
poor excellent


 

The Doctor:

  
9. The amount of time spent with your physician? 1 2 3 4 5

Comments:
poor excellent


 
10. His or her listening ? 1 2 3 4 5

Comments:
poor excellent


 
11. His or her explanation of procedures, diagnoses,
or treatment regimen?		 1 2 3 4 5

Comments:
poor excellent


 
12. His or her "bedside manner"? 1 2 3 4 5

Comments:
poor excellent


 
13. If you have visited our practice before, how convenient did you find:
Prescription refills (if appropriate)?		 1 2 3 4 5

Comments:
poor excellent


 
14. Getting lab results (if appropriate)? 1 2 3 4 5

Comments:
poor excellent


 
15. Overall, how would you rate our practice? 1 2 3 4 5

Comments:
poor excellent

 
 
 
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Trinity Family Medical Center, P.A.
1707 Mayo Dr.
Tavares, FL 32778
(352) 253-2511
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