Center for Heart & Health

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Patient Satisfaction Survey

In order to further improve our service we ask that you complete the patient satisfaction survey. All responses are strictly confidential, and will be used to enhance the service you receive at The Center for Heart and Health

Your Doctor:

Your Physiologist:

Scheduling Your Appointment	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Your phone call was answered promptly	1	2	3	4	5
Our receptionist was friendly and helpful	1	2	3	4	5
Your Appointment time was convenient and met your needs	1	2	3	4	5
Comments:

Your Appointment	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Your stay in the waiting room was appropriate	1	2	3	4	5
Your wait for the doctor in the exam room was an appropriate amount of time	1	2	3	4	5
The nurse was courteous and helpful	1	2	3	4	5
The doctor was courteous	1	2	3	4	5
The doctor gave proper attention to your problem	1	2	3	4	5
The doctor answered your questions	1	2	3	4	5
Comments:

Miscellaneous services	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Phone calls are answered in a timely manner	1	2	3	4	5
Email questions are answered in a timely manner	1	2	3	4	5
The X-ray technician was courteous and helpful	1	2	3	4	5
The laboratory technician was courteous and helpful	1	2	3	4	5
Comments:

Facilities	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The waiting area was clean	1	2	3	4	5
The exam room was clean	1	2	3	4	5
The laboratory was clean	1	2	3	4	5
The restroom was clean	1	2	3	4	5
The locker room and shower facilities were clean	1	2	3	4	5
The validated free parking was convenient	1	2	3	4	5
Comments:

Other services you would like us to offer

Comments:

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Your Email (Optional)
Telephone number if you would like a follow-up call to discuss your concerns:

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