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How long have you been coming to our office?
 
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
 
I have never been to your office
 
 
How often do you view our website when you are searching for additional information regarding a health topic?
Can't say Always Frequently Once or twice Never
main website page
directions
Common Conditions
Doctors profile
Safety topics
Endoscopic carpal tunnel
Dupuytren's Disease Update:Xiaflex and Needle Aponeurotomy
I look at your face book pages mostly
I've never seen any of your online material
 
 
 
Where do you first hear about our office?
 
From another patient
 
Online
 
Yellow pages
 
Television advertisment
 
My primary doctor
 
Another specialist
 
Emergency Room referral
 
By Reputation
 
Other
 
 
 
 
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
Customer service experience
On-time delivery of services
Professionalism
Billing experience
Quality of service
Understanding of patient's needs
 
 
 
How do we rate in comparison to other practices that you have been to?
 
Much higher
 
Somewhat higher
 
Same
 
Somewhat lower
 
Much lower
 
Don't know
 
 
 
How likely are you to continue using our services?
 
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
 
 
 
 
If you need services such as those offered by our office again how likely are you to call us for an appointment?
 
I will call you first
 
Only after I call my Primary doctor
 
Only if I have a severe problem
 
I may call you but I may try another office first
 
I may call you only after I try another office first
 
I will not be calling you again
 
I may look things up on your website but thats it
 
Prefer not to answer
 
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