Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time.

  1. Your Sex:
  2. Please select how well we are doing in the following areas:
  3. Rate your ease of getting care:
  4. Ability to get in to be seen:
  5. Hours Center is open
  6. Convenience of Center's location
  7. Prompt return on calls
  8. Rate our waiting time:
  9. Time in waiting room
  10. Waiting for tests to be perform
  11. Waiting for test results
  12. Rate our Staff:
  13. Dr. Sarbak
  14. Listens to you
  15. Gives you good advice and treatment
  16. Nurses and Medical Assistants:
  17. Friendly and helpful to you
  18. Answers your questions
  19. All Others:
  20. Friendly and helpful to you
  21. Answers your questions
  22. Payment:
  23. Explanation of insurance filing procedure
  24. Explanation of charges
  25. Collection of payment/money
  26. Facility:
  27. Neat and clean building
  28. Ease of finding where to go
  29. Comfort and safety while waiting
  30. Privacy
  31. Confidentiality:
  32. Keeping my personal information private
  33. The likelihood of referring your friends and relatives to us
  34. Do you consider this center your regular source of care?
  35. Permission to use my comments on website.
  36. Captcha

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