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Patient Satisfaction Survey

Dear Patient:

We know that you have a choice of physicians and we thank you for choosing this practice. We hope that you found our office friendly and caring. In an effort to provide you with the best possible care, we would appreciate your time to answer the following questions about your experience.


Which physician did you see?
       
Raymond C. Hurlbutt, DPM Steven B. Smith, DPM
Jill L. Jackson-Smith, DPM Timothy J. Siegfried, DPM
Jeremy M. Mason, DPM
Which location did you visit?
       
Broken Arrow Office Owasso Office
Tulsa Office Sapulpa Office
A. CONVENIENCE/ACCESSIBILITY
        1. Was the office easily reached by telephone? Yes No
        2. Was the office location convenient? Yes No
        3. How long was the wait to obtain your appointment?
        4. How long was the wait to see your doctor?
B. COMMUNICATIONS
        1. Did the doctor/staff answer your questions satisfactorily? Yes No
        2. Did you understand the answers to your questions? Yes No
        3. Was the information provided helpful? Yes No
C. TECHNICAL
        1. Was the examination thorough? Yes No
        2. Was the quality of care provided appropriate? Yes No
        3. Was the physician's knowledge, training, and overall skills acceptable? Yes No
D. INTER-PERSONAL SERVICE
        1. Was the office staff courteous and professional? Yes No
        2. Did the physician exhibit interest and concern? Yes No
        3. Did you feel the physician gave you sufficient time? Yes No
E. OFFICE APPEARANCE
        1. Was the office neat and orderly? Yes No
        2. Was their adequate parking available? Yes No
        3. Was their handicap accessibility? Yes No
Please rate the overall service and care you received:

Poor     1     2     3     4     5     Excellent
What pleased you most about your visit?
Is there something we could have done to make your visit more pleasant?
Signature welcome, but not required.

 

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