PATIENT SURVEY
KATT Trial
 
Patient Satisfaction Survey

Thank you for taking the time to share your thoughts about the care you received. In completing this questionnaire you will help us maintain and improve the care you and others receive. Your responses are strictly confidential.
Please indicate your provider:














1. Please indicate if you are:
2. How satisfied were you with the promptness and professionalism
of the person who helped arranged/schedule your office visit?:



3. Please describe your opinion of the communications with our office.

Initial Communication:




Follow up communication:



4. How satisfied were you with the waiting times you experienced on the day of your office visit?:



5. During what part of your visit was your longest wait time?:



6. The courtesy & friendliness of the receptionist at the office:



7. The courtesy & friendliness of the
Medical Assistant who took your Vitals, Medications, and Allergies:



8. The respect and concern shown by your physician on the day of your office visit:



9. The way your physician listened when you
explained your medical needs and concerns about the reason for your office visit:



10. How would you rate your experience with the new website:




10a Were you aware of our new web site?:
If not, why?:
:
11. How would you rate your experience with our current phone system:



12. Overall, how
satisfied were you with the quality of care & services you received at the office?:



13. If there was anything we could have done to improve your visit, what would that have been?

14. If you would like to be contacted regarding this survey or any other
aspect of your care, please provide your name and phone number here (OPTIONAL):


Thank you for taking time to share your thoughts,

The physicians and staff at South Denver Gastroenterology