Office/Clinic Survey example
This is an example Office/Clinic Survey survey. This survey includes questions like:
What was the purpose of your visit to our office/clinic?
Did you have an appointment?
How long did you have to wait before you were seen by a doctor?
We hope this will help you create your own Office/Clinic Survey survey. We
have not tested the validitiy or reliability of this survey. However, you may
use this as a starting point to help your own survey instrument. Feel free to
change and edit any of our survey templates to help you get started.
1) What was the purpose of your visit to our office/clinic?
2) Did you have an appointment?
3) How long did you have to wait before you were seen by a doctor?
Select one...
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?
5) How satisfied were you with the way you were treated by the nurse?
7) The amount of time the doctor spent with you?
8) The amount of time you had to wait before being seen by a doctor?
9) How satisfied were you with the way your questions were answered?
10) How would you rate the courtesy you were shown by staff at our office?
Please tell us how much you agree or disagree with the following statements: 11) The staff were knowledgeable.
12) The staff were friendly and courteous.
13) The nurse was knowledgeable.
14) The nurse was friendly and courteous.
15) The doctor was knowledgeable.
16) The doctor was friendly and courteous.
17) My questions were answered fully.
18) I was given complete attention by the doctor.
19) My visit to the office/clinic was a pleasant experience.
20) Overall, would you say your visit to our office was very positive, somewhat positive, somewhat negative or 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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