Office/Clinic Survey Web Template: Web survey from Survey Share's library of Medical templates. This particular web survey is concerned with Office and Clinic issues. These questions are intended for patients to answer,not doctors or staff. It is a Patient satisfaction survey of physicians office possessing staff and doctor satisfaction and waiting times. Edit this web survey and put in on the Web for free by signing up for the SurveyShare Web survey tool. You can get started free of change and create a free web survey of your own.         1) What was the purpose of your visit to our office/clinic? 2) Did you have an appointment? Yes No 3) How long did you have to wait before you were seen by a doctor? -- Select Here -- Less than 5 Minutes 5-10 Minutes 11-20 Minutes 21-30 Minutes More than 30 Minutes Please tell us how satisfied or dissatisfied you were with each of the following: 4) How satisfied were you with the way you were treated by the staff at our office? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 5) How satisfied were you with the way you were treated by the nurse? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 6) The doctor? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 7) The amount of time the doctor spent with you? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 8) The amount of time you had to wait before being seen by a doctor? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 9) How satisfied were you with the way your questions were answered? Very Satisfied Somewhat Satisfied Undecided Somewhat Dissatisfied Very Dissatisfied 10) How would you rate the courtesy you were shown by staff at our office? Excellent Good Fair Poor Don't Know Please tell us how much you agree or disagree with the following statements: 11) The staff were knowledgeable. Strongly Disagree Disagree Undecided Agree Strongly Agree 12) The staff were friendly and courteous. Strongly Disagree Disagree Undecided Agree Strongly Agree 13) The nurse was knowledgeable. Strongly Disagree Disagree Undecided Agree Strongly Agree 14) The nurse was friendly and courteous. Strongly Disagree Disagree Undecided Agree Strongly Agree 15) The doctor was knowledgeable. Strongly Disagree Disagree Undecided Agree Strongly Agree 16) The doctor was friendly and courteous. Strongly Disagree Disagree Undecided Agree Strongly Agree 17) My questions were answered fully. Strongly Disagree Disagree Undecided Agree Strongly Agree 18) I was given complete attention by the doctor. Strongly Disagree Disagree Undecided Agree Strongly Agree 19) My visit to the office/clinic was a pleasant experience. Strongly Disagree Disagree Undecided Agree Strongly Agree 20) Overall, would you say your visit to our office was very positive, somewhat positive, somewhat negative or very negative? Very Positive Somewhat Positive Undecided Somewhat Negative Very Negative 21) What, if anything, did you like most about your visit to our office? 22) What, if anything, did you like least about your visit to our office? 23) Please tell us what, if anything, we can do to make future visits to our office more pleasant for you.

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