Doctor-patient interaction survey

survey for after a patient has an appointment with a physician and how the interaction went
Name (optional): 


  1. How was your overall visit with this physician today?
      1 2 3 4 5  
    Excellent   Poor


  1. Was this a new consult or a follow-up appointment? 


  1. Did the physician explain things to you in a way you could understand?
    Yes
    No


  1. Explain how the physician did not meet your expectations of being able to understand what he was saying?


  1. Were all of your questions answered to your satisfaction?
    Yes
    No


  1. How would you rate the communication between you and your physician?
      1 2 3 4 5  
    Excellent   Poor


  1. Did you meet with a nurse, case manager or nurse navigator, that may have answered some of your questions for you? If so which one and were they helpful?


  1. If you visit other facilities for doctors appointments, how does this facility compare with their services?
      1 2 3 4 5  
    Excellent   Poor


  1. Did you feel the provider was prepared for your appointment?
    Yes
    No


  1. Did you leave your appointment feeling confident in your care plan?
    Yes
    No


  1. If you did not leave feeling confident, what were the reasons?


  1. Would you recommend this physician to your friends and family?
    Yes
    No





Mrs. Fauchier