Baltimore Cosmetic Surgeon | Patient Satisfaction Questionnaire 09

PATIENT SATISFACTION QUESTIONNAIRE

Today’s Date: 5/30/2007

Dear Patient,

Have you been wanting to tell us what you think? We’d love to know! Would you please help us improve our patient care by completing this anonymous questionnaire? We welcome your comments!

I.	OFFICE STAFF AND PROCEDURES
	A.	In your initial contact by phone, were our receptionists
		-	Courteous?	Yes	No
		-	Helpful?	Yes	No
	B.	During your visits to our office, were our receptionists
		-	Friendly?	Yes	No
		-	Responsive?	Yes	No
	C.	Did the waiting time seem reasonable to you?		Yes	No

	D.	What was your source of referral to our practice? If more than one applies, please indicate order of importance.
		Family / Friend____________			Physician____________
		Print Media ________________			Other______________
		Website name or search engine____________
II.	THE CONSULTATION PROCESS
	A. Was your consultation educational and helpful in understanding:
		-	the surgery to be done?	Yes	No
		-	the potential risks and complications?	Yes	No
	B.	Were all of your questions answered?
		Yes
	C.	Was accreditation of the surgeon important to you?
		Yes
	D.	Was accreditation of the facility important to you?
		Yes
	E.	What do you think of our brochure and letters?
		Wonderful.
	F.	Did you consider any other plastic surgery office? Yes No
		If yes, why did you choose our office rather than the others?
		Professional & caring.
		If no, why did you only consider our office?
III.	STAFF AND SURGERY SCHEDULING
	A. In your initial visit to our office, was our staff:
		-	Informative?	Yes	No
		-	Caring?	Yes	No
		-	Professional?	Yes	No
	B. Were your financial arrangements made in a professional and unembarrassing manner?
		Yes, all was arranged beforehand.
	C.	After the surgery was scheduled, did the amount of contact by the staff meet your pre-operative needs?
		Yes
	D.	Do you feel the staff was easily accessible if you had a question or concern?
		Yes
	E.	What did you think about the pre-operative package and post-op instructions?
		Very informative and helpful.
	F.	Is there anything the staff could have done to improve your experience?
		Not at all. No complaints.
IV.	PHYSICIAN AND SURGERY
	A.	Was your surgeon
		-	Knowledgeable?	Yes	No
		-	Caring?	Yes	No
		-	Thorough?	Yes	No
		-	Professional?	Yes	No
		-	Patient?	Yes	No
	B.	Did your pre and post-operative care meet your needs?
		Yes
	C.	How do you feel about your surgical result?
		Extremely happy.
	D.	Is there anything your surgeon could have done to improve your experience?
		Not at all
V.	FOLLOW UP
	A.	If there were a need for you to have plastic surgery again, would you return to our office?
		Without hesitation
	B	Do you recommend our office to your friends or relatives considering plastic surgery?
		Yes!
VI.	We welcome your comments and suggestions:
	I had a overall wonderful experience!


	Name (optional):________________

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