Relentless Pursuit of Perfection

Cholla Medical Group: Patient Satisfaction Survey

We value you as a patient and with each visit we strive to provide exceptional service. We ask you to take a moment to complete this survey. Your participation is sincerely appreciated and will be used to help improve our services.

    Who is filling out the survey?

    PatientPOAOther

    Patient Demographic information

    Gender

    MaleFemale

    Race

    WhiteHispanic/LatinAfrican-AmericanOther

    Marital Status

    SingleMarriedWidowed

    Insurance Status

    MedicareMedicaidCommercial (BCBS, Cigna, Aetna, etc.)Uninsured

    Full Time AZ Resident

    YesNo

    Please let us know how well you think we are doing in the following areas

    1) Ease of getting care

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Ability to be seen for a check-up or routine care

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Ability to be seen for care you needed right away

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Convenience of office hours

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Phone call hold times kept under 5 minutes

    Great

    Good

    OK

    Fair

    Poor

    N/A

     

    Comments regarding Ease of Getting Care?

    2) Customer Service (Receptionists)

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Friendly and helpful to you

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Treats you with courtesy and respect

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Answers your questions

    Great

    Good

    OK

    Fair

    Poor

    N/A

     

    Comments regarding Customer Service (Receptionists)?

    3) Medical Assistants

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Friendly and helpful to you

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Treats you with courtesy and respect

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Answers your questions

    Great

    Good

    OK

    Fair

    Poor

    N/A

     

    Comments regarding Medical Assistants?

    4) Your Primary Care Physician

    Please select your primary care physician:

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Listens to you

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Takes enough time with you

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Explains what you want to know

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Gives you good advice and treatment

    Great

    Good

    OK

    Fair

    Poor

    N/A

     

    Comments regarding Your Primary Care Physician?

    5) Follow-Up Care

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Informed of results on labs and tests ordered

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Prompt refills of medications within 3 business days

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Prompt answers/return of phone calls about medical questions

    Great

    Good

    OK

    Fair

    Poor

    N/A

     

    Comments regarding Follow-Up Care?

    6) Would you refer us to friends and family?

    Great

    Good

    OK

    Fair

    Poor

    N/A

    The likelihood of referring your friends and relatives to us:

    Great

    Good

    OK

    Fair

    Poor

    N/A

    Please answer the following questions:

    7) Approximately how long have you been a patient with this practice?

    Less than 6 monthsAt least 6 months but less than 1 yearAt least 1 year but less than 3 yearsAt least 3 years but less than 5 years5 years or more

    8) If you are no longer a patient in our practice, why did you leave?

    LocationPhysicianOfficeStaffThis question does not apply to meOther

    9) How did you hear about our practice?

    Friend or family memberAnother physician/specialistHealth plan/insurance company or associated directoryOnlineOther

    Please answer the following questions about the survey

    10) Were the survey questions easy to understand?

    YesNo

    11) Was the survey easy to complete?

    YesNo

    12) Approximately how long did it take to finish this survey?

    5 minutes or less10 minutes15 minutes20 minutes or longer

    Additional Comments