Physician Performance Evaluation Survey

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0

Name of doctor
0

How long has this doctor been treating you?
This was my first time

Less than a month

1- 6 months

7 months to 1 year

More than a year
0

Rate the ease of booking an appointment with the doctor.

Tough

Effortless

Tough

Effortless

0 Tough

1

2

3

4

5

6

7

8

9

10 Effortless
0

How well does the doctor respond to emergency situations?
0

How well did the doctor understand your problem?
Not at all

Very little

Somewhat

Well

Very well
0

How well did the doctor appear to know the subject at hand?
Not at all

Very little

Somewhat

Well

Very well
0

On a scale of 0-10, How satisfied are you with the treatment recommended?

Extremely dissatisfied

Extremely satisfied

Extremely dissatisfied

Extremely satisfied

0 Extremely dissatisfied

1

2

3

4

5

6

7

8

9

10 Extremely satisfied
0

Rate the doctor's facilities on the following aspects:
Cleanliness

Awful

Bad

Neutral

Good

Excellent

Hygiene (Instruments)

Awful

Bad

Neutral

Good

Excellent

Ambiance

Awful

Bad

Neutral

Good

Excellent

Location

Awful

Bad

Neutral

Good

Excellent

Waiting area

Awful

Bad

Neutral

Good

Excellent

Cleanliness

Hygiene (Instruments)

Ambiance

Location

Waiting area

Awful

Bad

Neutral

Good

Excellent
0

On a scale of 1-10, rate your overall satisfaction with your physician:

Extremely dissatisfied

Extremely satisfied

Extremely dissatisfied

Extremely satisfied

0 Extremely dissatisfied

1

2

3

4

5

6

7

8

9

10 Extremely satisfied
0

How likely are you to recommend your physician to your family and friends?

Not at all likely

Extremely likely

0 1 2 3 4 5 6 7 8 9 10
0

Do you have any suggestions for the doctor?

0 / 5000

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0

Name of doctor
0

How long has this doctor been treating you?
This was my first time

Less than a month

1- 6 months

7 months to 1 year

More than a year
0

Rate the ease of booking an appointment with the doctor.

Tough

Effortless

Tough

Effortless

0 Tough

1

2

3

4

5

6

7

8

9

10 Effortless
0

How well does the doctor respond to emergency situations?
0

How well did the doctor understand your problem?
Not at all

Very little

Somewhat

Well

Very well
0

How well did the doctor appear to know the subject at hand?
Not at all

Very little

Somewhat

Well

Very well
0

On a scale of 0-10, How satisfied are you with the treatment recommended?

Extremely dissatisfied

Extremely satisfied

Extremely dissatisfied

Extremely satisfied

0 Extremely dissatisfied

1

2

3

4

5

6

7

8

9

10 Extremely satisfied
0

Rate the doctor's facilities on the following aspects:
Cleanliness

Awful

Bad

Neutral

Good

Excellent

Hygiene (Instruments)

Awful

Bad

Neutral

Good

Excellent

Ambiance

Awful

Bad

Neutral

Good

Excellent

Location

Awful

Bad

Neutral

Good

Excellent

Waiting area

Awful

Bad

Neutral

Good

Excellent

Cleanliness

Hygiene (Instruments)

Ambiance

Location

Waiting area

Awful

Bad

Neutral

Good

Excellent
0

On a scale of 1-10, rate your overall satisfaction with your physician:

Extremely dissatisfied

Extremely satisfied

Extremely dissatisfied

Extremely satisfied

0 Extremely dissatisfied

1

2

3

4

5

6

7

8

9

10 Extremely satisfied
0

How likely are you to recommend your physician to your family and friends?

Not at all likely

Extremely likely

0 1 2 3 4 5 6 7 8 9 10
0

Do you have any suggestions for the doctor?

0 / 5000