Patient Information at Rockford Spine Center
For Patients
Patient Stories

Patient Satisfaction Survey

Dear Patient,
Please take a few minutes of your time to help us. Our goal is to provide comfort, convenience, and satisfaction as well as the very best medical care to all our patients. We'd like to know how you feel about our medical services, our patient-handling systems, our physicians, and staff members. Your comments will help us evaluate our operations to ensure that we are truly responsive to your needs. Thank you for you help.

Please rate the following:

Your appointment

Please check back for online forms, we our doing maintance on our site!
   

Excellent

Very Good

Good

Fair

Poor

N/A

1.

Ease of making appointments by phone

2.

Waiting time in the reception area

3.

Waiting time in the exam room

4.

Keeping you informed if your appointment time was delayed

 

Our staff

   

Excellent

Very Good

Good

Fair

Poor

N/A

5.

The friendliness and courtesy of the receptionist

6.

The courtesy of our nurses/medical assistants

7.

Phone calls are returned within the next business day

8.

The helpfulness of the people in our business office

9.

The courtesy and professionalism of our x-ray staff

 

Your visit with the doctor

   

Excellent

Very Good

Good

Fair

Poor

N/A

10.

The doctor listening to you

11.

The doctor taking time to answer your questions

12.

Amount of time the doctor spent with you

13.

The doctor's explanation of treatment options was adequate to your understanding

14.

The doctor's instructions regarding medication/follow-up care

 

Your overall satisfaction with

   

Excellent

Very Good

Good

Fair

Poor

N/A

15.

Our practice

16.

The quality of your medical care

17.

Would you recommend the doctor to others?

18.

If no, please tell us why:

19.

If there is any way we can improve our services to you, please tell us:

 

Some information about you

20.

Male/Female:

21.

Your Age:

22.

Insurance Company:

23.

Provider's Name:

 

Security Question

To help reduce the number of automated spam submissions made through this form - we ask that you please type in the displayed text exactly as shown:



Bookmark and Share