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Patient Satisfaction Survey

Dear Patient,
Recently you were treated by one of the physicians at NeuroSpine and Pain Center. Thank you for selecting our group to assist you in the diagnosis and treatment of your medical condition.

The goal of our practice is to provide you, the patient, with superior quality of care, both from our clinical staff of doctors, nurses and technicians, and from our business staff of receptionists, schedulers, insurance counselors and cashiers.

We would be grateful if you would take a moment to complete our patient survey. Your responses are completely confidential. The input you provide will help us assess how we are doing in meeting the patient care goals we have set for ourselves.

Again, thank you for utilizing the services of the physicians of NeuroSpine and Pain Center.

Sincerely,

Stephen R. Smith, Administrator

Required * First Name  * Last Name  * E-mail Address  * My doctor/nurse practitioner is:  * Dr. Al Hamda  Dr. Banas  Dr. Bhat  J. Born  Dr. Brinkman  Dr. Bultemeyer  Dr. Canavati  Dr. Chang  A. Christlieb  Dr. Curfman  Dr. Dodzik  Dr. Dozier  C. Gillig  Dr. Goff  Dr. Gupta  Dr. J. Kachmann  Dr. R. Kachmann  Dr. Khan  Dr. Later  Dr. Lutz  Dr. Mueller-Kronast  Dr. Munz  Dr. Osborne  Dr. Ottinger  Dr. Phuong  Dr. Schreier  S. Sible  A. Smith-Mishler  K. Springer  Dr. Stemler  Dr. Stevens  Dr. R. Williams  Dr. T. Williams  Dr. Young  I am seen at: 2622 Lake Ave. Fort Wayne, IN 46805  7956 W. Jefferson Blvd. Fort Wayne, IN 46804  1000 Medpark Dr. Warsaw, Suite D IN 46580  01. Are appointments scheduled at convenient times? Poor  Fair  Good  Excellent  N/A  02. How long was your wait to get an appointment? Poor  Fair  Good  Excellent  N/A  03. When telephoning our office, are your calls handled in a prompt and courteous manner? Poor  Fair  Good  Excellent  N/A  04. Did the nurse handle your calls promptly and provide the information you requested? Poor  Fair  Good  Excellent  N/A  05. Did the physician’s nurse return your call promptly? Poor  Fair  Good  Excellent  N/A  06. When you had an urgent problem and needed an appointment, how long did you have to wait? More than 4 weeks  3-4 weeks  1-5 days  N/A  07. Did you find our office to be clean and comfortable? Poor  Fair  Good  Excellent  N/A  08. Is parking easy and convenient? Poor  Fair  Good  Excellent  N/A  09. Does our staff treat you in a compassionate and professional manner? Poor  Fair  Good  Excellent  N/A  10. Is our receptionist friendly and responsive to your questions? Poor  Fair  Good  Excellent  N/A  11. How long did you wait at the office before you saw the physician/nurse practitioner? More than 30 min.  20-30 min.  10-20 min.  5-10 min.  12. Did you receive adequate information on your appointments: Poor  Fair  Good  Excellent  13. Did you receive adequate information on our office hours? Poor  Fair  Good  Excellent  N/A  14. Did you receive adequate information about medical emergencies? Poor  Fair  Good  Excellent  N/A  15. Did you receive adequate information about insurance and payments? Poor  Fair  Good  Excellent  N/A  16. Who is paying the majority of your healthcare bill? - (CNTRL Click for multiple options.) Medicare  HMO, PPO, Other Managed Care  Medicaid  Private/Corporate  Workmen’s Compensation  Self  Other  Unknown  17. If you had surgery, was our staff helpful in preparing you for surgery? Poor  Fair  Good  Excellent  N/A  18. Do you feel your physician/nurse practitioner listens to you and understands your problem(s)? Poor  Fair  Good  Excellent  N/A  19. How would you describe the technical skills (thoroughness, carefulness, competence) of the physician/nurse practitioner? Poor  Fair  Good  Excellent  N/A  20. Does your physician/nurse practitioner give you an opportunity to ask questions? Poor  Fair  Good  Excellent  N/A  21. Were you encouraged to participate in the decision-making of your treatment plan? Poor  Fair  Good  Excellent  N/A  22. Does your physician/nurse practitioner adequately follow up on your concerns? Poor  Fair  Good  Excellent  N/A  23. How thorough was the explanation of what was done? Poor  Fair  Good  Excellent  N/A  24. How would you describe the personal manners (courtesy, respect, sensitivity, friendliness) of the physician/nurse practitioner? Poor  Fair  Good  Excellent  N/A  25. Compared with other specialists/surgeons, how are our fees? Poor  Fair  Good  Excellent  N/A  26. Would you recommend our office to family/friends? Poor  Fair  Good  Excellent  N/A  27. The overall rating of your visit? Poor  Fair  Good  Excellent  N/A  (Optional Comments) The thing I like MOST about your practice is: (Optional Comments) I would recommend you making the following change(s):