Patient Satisfaction Survey
Are you a new patient to our facility?
Yes
No
How did you hear about our Sunrise Medical?
Friend
Relative
Referral from physician
Social Media, Newspaper, etc.
Other
How satisfied are you with the appointment scheduling process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How satisfied are you with check in and welcoming process?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
How satisfied are you with the physician?
Not Satisfied
1
2
3
4
5
6
7
8
9
Very Satisfied
10
1 is Not Satisfied, 10 is Very Satisfied
Please provide your feedback for your answers above.
Please rate the followings
Professionalism of staff
1
2
3
4
5
Hygiene in the facility
1
2
3
4
5
Kindness of medical personnel
1
2
3
4
5
Care provided by the doctor
1
2
3
4
5
By considering overall experience with our facility, how likely would you recommend to your friends/family?
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
Please share any comments/suggestions below.
Thank you for your feedback.
We will review the information provided, to ensure that we are able to provide the best possible care to all of our patients.
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