Patient Survey - IFHS

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- DIRECTOR OF OPERATIONS AND FINANCE

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

BUSINESS HOURS
Monday - Friday 8:30 AM - 6:00 PM
Saturday 8:30 AM - 1:00 PM
IFHS will be closed from noon to 1:00 PM, Monday through Friday only.
IFHS OPENS AT 9:30 AM the third Wednesday of each month due to our all staff meeting.

BILLING QUESTIONS: (386) 274-4802

CLINIC Telephone: (907) 581-1202