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» Patient Feedback Questionnaire
Your Visit:
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Follow up consultation
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Your Age:
Your Insurance:
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Your Sex:
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Please circle how well you think we are doing in the following area:
GREAT
GOOD
OK
FAIR
POOR
Ease of getting care:
Ability to get in to be seen
Clinic/Surgery times
Convenience of hospitals location
Prompt return on calls
Waiting:
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results
Staff:
Katherine J. Coyner, M.D
Listens to you
Takes enough time with you
Explains what you want to know
Gives you good advice and treatment
Nurses and Medical Assistants:
Friendly and helpful to you
Answers your questions
All Others:
Friendly and helpful to you
Answers your questions
Payment :
What you pay
Explanation of charges
Collection of payment/money
Facility:
Neat and clean building
Parking
Ease of finding where to go
Comfort and Safety while waiting
Privacy
Confidentiality:
Keeping my personal information private
The likelihood of referring your friends and relatives to us:
Total Score %:
What do you like best about our centre?
What do you like least about our Centre?
Suggestions for improvement?
How did you select Katherine J. Coyner, M.D? Please, check all that apply.
Doctor's recommendation
Facebook
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Friends/Family/Co-worker
Yellow Pages
Google
Referral Service
Yahoo
TV Commercial
Worker's Comp
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Print Ad - Newspaper
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Have you visited our website:
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© Katherine J. Coyner M.D. Orthopaedic Surgeon Specializing in Sports Medicine Dallas Texas
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