PATIENT 3 SATISFACTION QUESTIONNAIRE

Today’s Date:  11/7/2007

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?  
    - Helpful?  
  B. During your visits to our office, were our receptionists  
    - Friendly?  
    - Responsive?  
  C. Did the waiting time seem reasonable to you?  
  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?  
    - the potential risks and complications?  
  B. Were all of your questions answered?  
    Y  
  C. Was accreditation of the surgeon important to you?  
    Y  
  D. Was accreditation of the facility important to you?  
    Y  
  E. What do you think of our brochure and letters?  
    nice  
  F. Did you consider any other plastic surgery office?  
    If yes, why did you choose our office rather than the others?  
    I felt comfortable right away. I felt good about Dr’s credentials  
    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?  
    - Caring?  
    - Professional?  
  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?  
    I asked multiple questions via telephone+email – both were immediately  
  E. What did you think about the pre-operative package and post-op instructions?  
    Professional and thorough  
  F. Is there anything the staff could have done to improve your experience?  
    Nothing  
IV. PHYSICIAN AND SURGERY  
  A. Was your surgeon  
    - Knowledgeable?  
    - Caring?  
    - 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?  
    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 I will return for my arms   +    legs  
  B Do you recommend our office to your friends or relatives considering plastic surgery?  
    Yes  
VI. We welcome your comments and suggestions:  
  I never had surgery or been in the hospital before. I was hardly nervous or concerned. All question were answered timely and efficiently. The lympindema message was helpful and being a message therapist, I am so pleased the health are professional values.. approach.  
 

 

 
     
 

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