James M. Parolie, MD
James W. Dwyer, MD
Paul P. Vessa, MD
Mingi Choi, MD

PATIENT SATISFACTION SURVEY

Dear Patient:

Please take just a few minutes to let us know how we are doing so we can continually improve our services. Thank you for your help.

Your name:

Your e-mail:

Date of Appointment:

Time of Appointment:

Physician:

 

 

 

 

 

HOW SATISFIED ARE
YOU WITH:

Very
Satisfied

Somewhat
Satisfied

Somewhat
Dissatisfied

Very
Dissatisfied

Not
Applicable

YOUR APPOINTMENT:


1. Appointment available within a reasonable amount of time

2. Appointment scheduled at a convenient time of day

3. Waiting time in the reception area

4. Waiting time in the exam room

4a. How long did you wait from time of check in until you saw the doctor?:

4b. If over 45 minutes, how long did you wait from time of check-in until you saw the doctor and what was your impression as to why?

 

OUR STAFF:

Very
Satisfied

Somewhat
Satisfied

Somewhat
Dissatisfied

Very
Dissatisfied

Not
Applicable

5. The friendliness and courtesy of our receptionists

6. The caring concern of our nurses

7. The helpfulness of the people in our business office

8. The professionalism of our technical staff

 

OUR COMMUNICATION
WITH YOU:

Very
Satisfied

Somewhat
Satisfied

Somewhat
Dissatisfied

Very
Dissatisfied

Not
Applicable

9. Your phone calls answered promptly

10. Availability of medical information/advice by telephone

11. Explanation of your test procedure (if applicable)

12. Your test results reported in a reasonable amount of time

13. Effectiveness of our health information materials

14. The doctor returning your calls in a timely manner

 

YOUR VISIT WITH
THE DOCTOR:

Very
Satisfied

Somewhat
Satisfied

Somewhat
Dissatisfied

Very
Dissatisfied

Not
Applicable

15. The doctor listening to you

16. The doctor taking time to answer your questions

17. The doctor adequately explaining treatment options

18. The thoroughness of the examination

19. Amount of time the doctor spent with you

20. The outcome of treatment prescribed by your doctor

 

OUR FACILITY:

Very
Satisfied

Somewhat
Satisfied

Somewhat
Dissatisfied

Very
Dissatisfied

Not
Applicable

21. Hours of operation convenient for you

22. Overall comfort

23. Adequate parking

24. Signage and directions easy to follow

OVERALL RATING


Excellent

Good

Fair

Poor

25. Our Practice

26. The Quality Of
Your Medical Care

27. WOULD YOU RECOMMEND OUR PRACTICE
TO A FAMILY MEMBER OR FRIEND?

Yes

No

If there is any way we can improve our services to you, please tell us about it:

Please check this box if you would like to speak with someone
about your experience in our office.



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1 Robertson Dr. • Bedminster, NJ 07921
Phone: (908) 722-0822 • Fax: (908) 722-6318
For more information email Somerset Orthopedics