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MD MEDICAL CLINICS

OCCUPATIONAL SERVICES
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PATIENT SATISFACTION SURVEY

 


PLEASE TELL US…………..

  1. Were all staff members polite and friendly?…………Yes   No
  2. How long did you wait in the waiting room? Short   Not too long  Too long
  3. How would you describe the total waiting time?
  4.                       Short   Not too long   Too long
  5. Did the Doctor answer your questions to satisfaction? Yes    No
  6. Did the nurse or Doctor introduce themselves?………. Yes    No
  7. Did you feel the staff was sympathetic to your condition? Yes   No
  8.  

    Regarding Therapy:I did not have therapy.__ (Skip to #10)

  9. Was the therapist courteous and professional?… Yes   No
  10. Was the treatment explained to you in detail?……… Yes   No
  11. 9. Was the staff attentive while you were in the treatment area?…..Yes   No

10. How would you describe your overall satisfaction with our services and your treatmentt?         Excellent   Very Good   Good   Fair    Poor

11. Would you recommend us to others?…………… Yes   No

12. Were you satisfied with the cleanliness and appearance of our office and staff?                Excellent   Very Good   Good   Fair   Poor

13. Do you have any comments or suggestions for improving our practice we would appreciate your input very much.

 

 



                                                                                                              Thank you,

YOUR MD MEDICAL CLINIC STAFF

We are working harder to serve you better!

Your Name__________________________________________________________________________

 

Company 

Name ____________________________________________________________________________________________________________

MD Medical Clinics 1300 N Kraemer Blvd., Anaheim, CA 92806

Please mail or email:mdmed@pacbell.net