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Restore Patient Satisfaction Survey

Ease of making appointments by phone
Very Easy
Easy
Neutral
Hard
Very Hard
Appointment available within a reasonable amount of time
Very Easy
Easy
Neutral
Hard
Very Hard
The efficiency of the check-in process
Excellent
Above Average
Average
Below Average
Poor
Waiting time in the reception area
Very Satisfied
Satisfied
Neutral
Disatisfied
Very Disatisfied
The courtesy of the person who took your call
Excellent
Above Average
Average
Below Average
Poor
The friendliness and courtesy of the receptionist
Excellent
Above Average
Average
Below Average
Poor
The caring concern of our nurses/medical assistants
Excellent
Above Average
Average
Below Average
Poor
The professionalism of our lab staff
Excellent
Above Average
Average
Below Average
Poor
Your ability to contact us after hours
Excellent
Above Average
Average
Below Average
Poor
Our ability to return your calls in a timely manner
Excellent
Above Average
Average
Below Average
Poor
Our ability to assist you obtain prescription refills
Excellent
Above Average
Average
Below Average
Poor
The doctor’s willingness to listen carefully to you
Excellent
Above Average
Average
Below Average
Poor
The doctor taking time to answer your questions
Excellent
Above Average
Average
Below Average
Poor
The doctor amount of time spent with you
Excellent
Above Average
Average
Below Average
Poor
The doctor explaining things in a way you could understand
Excellent
Above Average
Average
Below Average
Poor
The doctor’s instructions regarding medication/follow-up care
Excellent
Above Average
Average
Below Average
Poor
Which counselor better meets your needs
JD Waller
Chris Dowdy
Dr Thomas Feguson
Which physician better meets your needs
Dr Riggins
Dr Babbino
Which day and time would be best for you
Monday Morning
Tuesday Morning
Wednesday Morning
Thursday Morning
Friday Morning
Saturday
Monday after 5:00 pm
Tuesday after 5:00 pm
Wednesday after 5:00 pm
Thursday after 5:00 pm
Friday after 5:00 pm
How far do you drive to your appointments
5-10 miles
20 to 45 miles
45 to 75 miles
Over 75 miles
Have you ever been a patient at other similar clinics
Yes
No
How does Restore's service compare to other similar clinic services you have received?
Excellent
Above Average
Average
Below Average
Poor
N/A
What services would you like us to add to our current services offered?
What would you add or subtract from what we do to make us better?
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