Patient Satisfaction Survey

Appointment Date

Time

Please rate the following on a scale:

5 = Strongly Agree

4 = Agree

3 = Neutral

2 = Disagree

1 = Strongly Disagree

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1. The waiting time to schedule my appointment was acceptable 5 4 3 2 1

2. My appointment began at my scheduled appointment time. 5 4 3 2 1

3. The front office staff was pleasant and helpful. 5 4 3 2 1

4. My procedure/exam was properly explained to me. 5 4 3 2 1

5. My level of comfort and pain was recognized and controlled. 5 4 3 2 1

6. The nurses answered my questions completely and thoroughly and cared about how I was feeling. 5 4 3 2 1

7. Questions about my bill were answered quickly and thoroughly. 5 4 3 2 1

8. Webby Hills Cancer Center is clean and has a pleasant environment: 5 4 3 2 1

9. Webby Hills Cancer Center parking is convenient: 5 4 3 2 1

10. My overall experience at Webby Hills Cancer Center was excellent. 5 4 3 2 1

11. I will recommend Webby Hills Cancer Center to my friends, family, and those in need of excellent care and imaging services. 5 4 3 2 1

12. I will return to Webby Hills Cancer Center for my cancer/health care services 5 4 3 2 1

13. How did you hear about us? Pick one Physician Friend/Relative Health Fair Internet Media Other

Any additional comments or suggestions you would like to make?

Is it okay if we can use your comments in our marketing collateral such as testimonials. Yes, okay to use
No, not okay to use