Patients Satisfaction Survey ( Medical Group ) | Charlotte Gastroenterology and Hepatology

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Date
What Provider did you have your visit with today?
Which office did you visit?
Randolph Ballantyne Mooresville South Park Matthews Huntersville

1. When you called for your appointment, was your call handled in a timely and professional manner?	Yes No
2. Were you given an appointment in a timely manner?	Yes No
3. When checking in, did the receptionist acknowledge you in a timely and friendly manner?	Yes No
4. Upon checking out, did the cashier acknowledge you in a friendly manner and answer any questions you had?	Yes No
5. Were our fees/financial/insurance policies clearly explained to you?	Yes No
6. During your visit did the Provider listen to and answer your questions clearly?	Yes No
7. How long did you wait in our reception room? 0-15 minutes 16-30 minutes 31-45 minutes
8. How long did you wait in our exam room? 0-15 minutes 16-30 minutes 31-45 minutes
9. If you have called the office with a medical problem, did our clinical staff respond in a timely manner? 1-2 hours 2-4 hours end of day
10. Did you feel the Provider spent enough time with you during your visit?	Yes No
11. Would you refer our office to family or friends?	Yes No
12. Have you visited our website?	Yes No
13. How did you hear about our office?
14. Do you have any other suggestions or comments which may help us improve or expand the services we provide?

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