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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
Publications and Reports
IFHS Newsletter
IFHS Reports
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
Publications and Reports
IFHS Newsletter
IFHS Reports
Join Our Team