Serving Southwest Louisiana since 1962
Patient Satisfaction Survey
We would appreciate hearing from you!
Please rate us by answering the following questions. Place a check mark in the appropriate columns.
Patients Name (Optional):
Telephone Number:
Date Seen:
Usually seen at:
Main Office
Moss Bluff
Sulphur
South LC
Allergy
Jennings
Kid Med
Doctor(s) Usually Seen:
PHONE
Reaching office Monday-Friday office hours
Reaching office on weekend office hours
OPERATOR
Directs call appropriately
Friendly/Helpful
SCHEDULING APPOINTMENTS
Availability of appointment for sick child
Availability of appointment for check-up
Availability of physician of your choice
Friendly/Helpful
CHECKING IN
Friendly/Helpful
Length of time waiting to check-in
CHECKING OUT
Friendly/Helpful
Length of time waiting to check-out
Overall time for visits
NURSING STAFF
IN-OFFICE
Courteous directing to your room
Weighing and measuring your child
Friendly/Helpful
Knowledgeable/Informative
Made you feel comfortable
TELEPHONE ADVICE
Wait time on telephone
Satisfied with advice
PHYSICIANS
Friendly
Knowledgeable/Informative
Made you feel comfortable
Spent enough time with your child
Wait time in room
Satisfied with your child's medical treatment
OFFICE
Adequate parking
Cleanliness of building
Cleanliness of waiting room
Cleanliness of treatment room
AFTER HOURS PHONE SERVICE
Friendly
Knowledgeable/Informative
OTHER SERVICES (Used or in contact with)
Laboratory Department
X-Ray Department
Billing Office
Clarity of Billing Statements
Managed Care Department
Patient Services
Pharmacy
Medical Records
Accounts Receivable
Administration
Other:
Would you refer our office to a friend?
Yes
No
Has your child been seen at any of the satellite offices?
Yes
No
Where?
If yes, was the visit convenient?
Yes
No
If yes, was the visit satisfactory?
Yes
No
Would you return to a satellite office even if your regular doctor was not there for the visit?
Yes
No
COMMENTS
