Exit this survey Post-Visit Patient Satisfaction Template Begin Survey here: Question Title 1. Overall, how satisfied or dissatisfied were you with your last visit to our office? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title 2. How easy or difficult was it to schedule your appointment at a time that was convenient for you? Very easy Somewhat easy Neither easy nor difficult Somewhat difficult Very difficult Question Title 3. How convenient was the appointment time you were able to get? Extremely convenient Very convenient Moderately convenient Slightly convenient Not at all convenient Question Title 4. In your opinion, how convenient is the location of our office? Extremely convenient Very convenient Moderately convenient Slightly convenient Not at all convenient Question Title 5. Overall, how would you rate the service you received from the staff at our office? Excellent Very good Good Fair Poor Question Title 6. How comfortable was the lobby and waiting area? Extremely comfortable Very comfortable Moderately comfortable Slightly comfortable Not at all comfortable Question Title 7. Did your appointment with your provider start early, late or on time? Very early Somewhat early On time Somewhat late Very late Question Title 8. Overall, how would you rate the care you received from your provider? Excellent Very good Good Fair Poor Question Title 9. How much do you trust your provider to make medical decisions that are in your best interests? A great deal A lot A moderate amount A little Not at all Question Title 10. How well did your provider listen to your needs? Extremely well Very well Moderately well Slightly well Not at all well Question Title 11. How well did your provider answer your questions? Extremely well Very well Moderately well Slightly well Not at all well Question Title 12. How well did your provider explain your treatment options? Extremely well Very well Moderately well Slightly well Not at all well Question Title 13. How well did your provider explain your follow-up care? Extremely well Very well Moderately well Slightly well Not at all well Question Title 14. How satisfied or dissatisfied were you with the amount of time your provider spent with you addressing your needs? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title 15. My visit cost/nominal fee was reasonable. Yes No Question Title 16. How likely is it that you would recommend your provider to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 Question Title 17. What is your clinic location? Decatur, AL Florence, AL Muscle Shoals, AL Rogersville, AL Russellville, AL Town Creek, AL Bogalusa, LA Brandon, MS Brookhaven, MS Calhoun City, MS Columbia, MS Flowood, MS Grenada, MS Meadeville, MS Mendenhall, MS Monticello, MS New Hebron, MS Pearl, MS Pelahatchie, MS Prentiss, MS Raleigh, MS Tylertown, MS Winona, MS Woodville, MS Done Powered by See how easy it is to create a survey. Privacy & Cookie Notice