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Surveys
2011
November
P
Patient Satisfaction Survey
Patient Satisfaction Survey
Patient Satisfaction Survey
0%
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How long have you been coming to our clinic?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
How would you rate your overall level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
How do we rate on the following attributes?
Well Below Average
Below Average
Average
Above Average
Well Above Average
Timely delivery of care
Professionalism
Healthcare experience
Quality of service
Understanding of patients' needs
How do we rate in comparison to other facilities that offer the same services?
Much higher
Somewhat higher
Same
Somewhat lower
Much lower
Don't know
How likely are you to continue your care with us?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
Have you ever recommended us to others?
No, never recommended
Have recommended once or twice
Have recommended several times
Do you have any suggestions for improvement?
What is your gender?
Male
Female
Prefer not to answer
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed, looking for work
Unemployed, not looking for work
Student
Retired
Homemaker
Military
Prefer not to answer
Other
Which of the following categories best describes your annual income?
Under $15,000
$15,000 - $29,999
$30,000 - $44,999
$45,000 - $59,999
$60,000 - $74,999
$75,000 - $89,999
$90,000 or more
Prefer not to answer
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