Cosmetic Surgeons Baltimore | Patient Testimonial 2

PATIENT 2 SATISFACTION QUESTIONNAIRE

Today’s Date: 7/23/2007

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 Google
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?
		Excellent!
	F.	Did you consider any other plastic surgery office? Yes No
		If yes, why did you choose our office rather than the others?
		If no, why did you only consider our office?
		After Meeting with Dr. Lickstein I knew he was the Dr. I would want
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
	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, staff was great
	E.	What did you think about the pre-operative package and post-op instructions?
		Very Helpful, I read them often, very useful
	F.	Is there anything the staff could have done to improve your experience?
		No
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?
		Wonderful , I am so pleased!
	D.	Is there anything your surgeon could have done to improve your experience?
		No
V.	FOLLOW UP
	A.	If there were a need for you to have plastic surgery again, would you return to our office?
		Yes
	B	Do you recommend our office to your friends or relatives considering plastic surgery?
		Yes
VI.	We welcome your comments and suggestions:
	Everyone was great, the nurses , the staff and, without a doubt Dr. Lickstein. Dr. Lickstein is by far the best Doctor I have ever been to.


	Name (optional):_______________ Telephone #: ____________

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