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IFHS
Home
Our History
Medical Staff
Clinical Staff
Administrative Staff
Board of Directors
Patient Information
Appointments/Cancellations
Billing
Sliding Fee Discount Program
Patient Policies & Forms
Emergency
Contact Us
Patient Survey
Services
Medical
Laboratory & Radiology
Behavioral Health
Dental
Optometry
Pay My Bill
Join Our Team
Patient Survey
We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this confidential survey. Just let us know what we are doing well and what we can do better!
Name
*
First
Last
Date of Service/Visit
*
*
Indicates required field
Phone Number
*
Who was your physician/provider during your last visit?
*
Email
*
Please indicate your level of satisfaction with the following items related to your appointment.
Use a scale of 1 to 5, with 5 being Very Satisfied, and 1 being Not Satisfied.
Getting through to the office by phone.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
The time between your call to schedule an appointment and your appointment date.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
The manners of the person who scheduled your appointment.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satiesfied
Clarity of directions to the office and the time of your appointment.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
The professionalism and helpfulness of your receptionist.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 -Very satisfied
Your wait time in the office.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
The comfort, cleanliness, and amenities of the reception area.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
The extent to which staff respected your privacy.
*
1 - Not satisfied
2 - Somewhat not satisfied
3 - Neutral
4 - Somewhat satisfied
5 - Very satisfied
Please rate the following items related to the delivery of your care.
Use a scale 1 to 5, with 5 being very satisfied, and 1 being Poor.
Your physician/provider's listening skills.
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
Explanation of procedures, diagnoses, or treatment regimen.
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
His/her personal manner (courtesy, respect, sensitivity, friendliness).
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
Other staff's personal manner (courtesy, respect, sensitivity, friendliness).
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
Technical skills (thoroughness, carefulness, competence) of the physician/provider.
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
How prepared (records and educational materials readily available) the staff and physician/provider were for your visit.
*
1 - Very poor
2 - Poor
3 - Neutral
4 - Good
5 - Excellent
Please indicate the extent to which you agree or disagree with each of the following statements.
Use a scale of 1 to 5, with 5 being Strongly Agree, and 1 being Strongly Disagree.
My physician/provider spent adequate time with me.
*
1 - Strongly disagree
2 - Disagree
3 - Neutral
4 - Somewhat agree
5 - Strongly agree
The service/care provided was valuable to improving my health.
*
1 - Strongly disagree
2 - Disagree
3 - Neutral
4 - Somewhat agree
5 - Strongly agree
The educational information I received was helpful.
*
1 - Strongly disagree
2 - Disagree
3 - Neutral
4 - Somewhat agree
5 - Strongly agree
I clearly understand the next steps in my plan of care.
*
1 - Strongly disagree
2 - Disagree
3 - Neutral
4 - Somewhat agree
5 - Strongly agree
If lab work was done, did you receive your results in a timely manner following your office visit?
*
Yes
No
Not applicable
Would you return to see this physician/provider for further care?
*
Yes
No
Maybe
Would you recommend IFHS to family and friends?
*
Yes
No
Maybe
Did any specific staff member stand out?
*
Yes
No
Was there any aspect of your care that could be improved?
*
Yes
No
If yes, who and why?
*
If yes, please explain.
*
Please tell us what you like best about the care you received.
*
Please tell us what you like least about the care you received.
*
Do you have any other comment(s) you would like to share with us?
*
Submit
Home
Our History
Medical Staff
Clinical Staff
Administrative Staff
Board of Directors
Patient Information
Appointments/Cancellations
Billing
Sliding Fee Discount Program
Patient Policies & Forms
Emergency
Contact Us
Patient Survey
Services
Medical
Laboratory & Radiology
Behavioral Health
Dental
Optometry
Pay My Bill
Join Our Team