Patient Survey: Gainesville
Please give us the opportunity to provide you with quality care by providing feedback. We sincerely appreciate your time and assistance.
Please note the date and time of your appointment
Date Format: MM slash DD slash YYYY
Time
7:30 AM
7:45 AM
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
How long did you have to wait after your scheduled appointment time before you were seen by the provider?
<10 mins
10-20 mins
20-30 mins
>30 mins
On a scale from 1 to 5, with 5 being excellent and 1 being poor, please rate your satisfaction:
Appointment Scheduling
Was your appointment scheduled in a timely manner
*
5
4
3
2
1
N/A
Was our scheduling staff helpful and friendly
*
5
4
3
2
1
N/A
Timeliness of being of attended in procedure room
*
5
4
3
2
1
N/A
Facility
Convenience of parking
*
5
4
3
2
1
N/A
Atmosphere of facility/cleanliness
*
5
4
3
2
1
N/A
Privacy of medical information
*
5
4
3
2
1
N/A
Handicap accessibility
*
5
4
3
2
1
N/A
Office Staff
Efficiency of check in process/friendliness of receptionist
*
5
4
3
2
1
N/A
Efficiency of check out process/friendliness of receptionist
*
5
4
3
2
1
N/A
Helpfulness of nursing staff
*
5
4
3
2
1
N/A
Provider
Saw you on time
*
5
4
3
2
1
N/A
Explained your condition and answered questions
*
5
4
3
2
1
N/A
Had a caring attitude/bedside manner
*
5
4
3
2
1
N/A
Overall, how would you rate our practice?
*
5
4
3
2
1
N/A
If medication was prescribed, did we explain:
*
5
4
3
2
1
N/A
Why they were used?
How to take them?
Would you recommend CSPM to family/friends?
*
Yes
No
Comments
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