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Patient Satisfaction Survey

Dear Patient,
In order to further improve our service we ask that you complete the patient satisfaction survey. All responses are strictly confidential, and will be used to enhance the service you receive at South Bay Gastroenterology Medical Group.

Physician Seen:

Scheduling Your Appointment	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Your phone calls are usually answered promptly.	1	2	3	4	5
Our receptionist is always friendly and helpful.	1	2	3	4	5
You can schedule a convenient / timely appointment with your physician.	1	2	3	4	5
Our hours of operation are convenient for you.	1	2	3	4	5
Your physician answers your calls promptly.	1	2	3	4	5

Your Appointment	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
You usually wait less than 20 minutes to see your physician.	1	2	3	4	5
Your physician's nurse is always helpful and courteous.	1	2	3	4	5
Your physician is always professional and courteous.	1	2	3	4	5
Your physician listens to all of your concerns.	1	2	3	4	5
Your physician answers all of your questions.	1	2	3	4	5
Your physician adequately explains any tests or treatment options.	1	2	3	4	5
You are able to make a convenient / timely appointment for follow-up care.	1	2	3	4	5
You usually receive your test results in a timely manner.	1	2	3	4	5

Facilities
Was the office clean?	Yes	No
Were the examining rooms clean?	Yes	No
Were the restrooms clean?	Yes	No

Operations
Have you previously visited our website at www.southbaygastro.com?	Yes	No
Did you know our website contains useful information and tools for maintaining your health?	Yes	No
Are there additional services we can provide for you?	Yes	No
If yes, please explain:
Would you refer a friend to your physician?	Yes	No

South Bay Gastroenterology Medical Group likes to be an active member in the community. Do you know of any upcoming community events where we can volunteer our services?

Additional Comments:

Your Name (Optional)
Your Email (Optional)
Telephone number if you would like a follow-up call to discuss your concerns: