Patient Satisfaction Survey

Dear Patient:
In an ongoing effort to improve your and other patients' experiences with our office, we would
greatly appreciate if you would take a few moments to answer the following questions on this anonymous survey form. The only types of information we'll collect when you submit this survey form are your answers to the questions and the date/time when you click the Submit button at the bottom of the form.

- Please click on the option button in front of the best answer to each question. So that we get a complete picture of your experience, we really need your answers to all questions.

- Thanks so much for taking a few minutes of your time to help us deliver a high level of service to all of our patients!

(0) Would You Refer a Friend to Berks Cardiologists?

 Definitely Would Not Refer

Probably Would Not Refer

Might or Might Not Refer

Probably Would Refer

Definitely Would Refer

Not Applicable

(1) Ease in Scheduling Appointment
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

 
(2) Welcome by Receptionist 
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(3) Check-in Process
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(4) Appearance of the reception staff
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(5) Office Staff's help with your insurance paperwork
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(6) Waiting time in the lobby
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(7) Literature/reading materials in lobby
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(8) Adequacy of parking
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(9) Cleanliness in surroundings

Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(10) Friendliness and helpfulness of nursing staff during your visit
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(11) Availability of literature regarding your condition or illness

Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(12) Friendliness of the physician
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(13) Physician's concern for you
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(14) Physician's thoroughness
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(15) Physician's answers to your questions
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(16) Quality of information given by the clinical staff
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(17) Financial policies, arrangements, or payment plans
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(18) Check-out process is smooth and efficient
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

(19) Overall, how satisfied or dissatisfied you are with our services
Highly Dissatisfied  

Somewhat Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Satisfied

Highly Satisfied

Not Applicable

• That's all. Thanks again for completing our Patient Satisfaction Survey!

• Please click the Submit button below.