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Patient Survey     

PATIENT SATISFACTION SURVEY

Our ongoing mission is to continually improve our quality of sevice and the quality of you experience.
Please help us serve you better by taking a moment to give us your feedback. Feel free to use the comments section to elaborate on your answers. Thank you.

 How would you rate your overall service experience with our practice?

 Excellent
 Good
 Fair
 Poor              
How pleased were you with our service during your most recent visit with us?

Very pleased
Pleased
Neither pleased nor displeased
Displeased

Please rate the following criteria (scale of 1 to 5 with 5 being the best):                               
Telephone demeanor of staff

 1   2   3   4   5
    

Convenience of your appointment time

 1   2   3   4   5
    

Greeting upon arrival

 1   2   3   4   5
    

Helpfulness of our staff  1   2   3   4   5
    
Sensitivity & attentiveness of doctors  1   2   3   4   5
    
 Explanations provided / questions answered  1   2   3   4   5
    
 Are you aware that our practice is currently accepting new patients?  Yes   No
 Do you feel positive enough about our practice to refer  family or friends?  Yes    No
 Which office do you visit? Oneida  Norwich
New Hartford
 How far do you travel to come to our office?

 0-5 miles
5-10 miles
10-15 miles
15-30 miles 
Over 30 miles

 

 

 

 

 

 


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