Doctor Survey


  1. Do you feel your doctor gave you the appropriate amount of time for your appointment?
    Yes
    No


  1. Did you feel rushed through the appointment?
    Yes
    No


  1. Is your Doctor male or female
    Male
    Female


  1. Depending on your appointment time, how long did you wait in you room before you seen your doctor?
    less than 5 minutes
    10 to 15 minutes
    20 to 30 minutes
    more than 30 minutes


  1. Did you feel the confidential level was______?
    Excellent
    ok
    poor


  1. Professionalism of doctor
    1 2 3 4 5


  1. Would you refer your doctor to someone else?
    Yes
    No


  1. Professionalism of staff
    1 2 3 4 5


  1. Did you feel comfortable discussing all you questions and concerns with your doctor?
    Yes
    No


  1. How long have you been seeing your doctor?
    Once
    around 3 months
    around 6 months
    a year
    more than a year


  1. Friendliness of doctor
    1 2 3 4 5


  1. Friendliness of staff
    1 2 3 4 5


  1. Friendliness of receptionist
    1 2 3 4 5


  1. Was is easy to communicate with your doctor?
    Yes
    No


  1. Did you agree with your doctors treatment options and advice?
    Completely agreed
    agreed on some but not all
    did not agree


  1. Where all your questions clearly answered in terms you understood?
    Yes
    No


  1. Did you feel like you were treated with sincere respect?
    Yes
    No


  1. Professionalism of receptionist
    1 2 3 4 5





Mrs. Fauchier