Online Survey

You recently visited our facility and we want to be sure that you're satisfied with the outcome. Please complete this short survey. Your feedback will be used to improve our service.

Contact Information

Full Name
Email Address
Phone Number

Appointment Information

Date of the visit being reported
v
Physician who treated you

Survey

Please use this scale to answer the following questions.

1. Strongly Disagree  2. Disagree 3. Neutral 4. Agree 5. Strongly Agree 6. N/A

1) I was able to schedule my appointment for this visit within a reasonable amount of time.
2) When I called the office during regular office hours, I received the help or advice I needed.
3) If I had to leave a message, I received a call back within 24 hours.
4) Telephone operator was courteous and professional.
5) Front office staff was efficient and courteous.
6) Nursing and medical assisting staff were knowledgeable and professional.
7) X-ray technologist was courteous and professional.
8) Billing staff were knowledgeable and professional.
9) The doctor was concerned, knowledgeable and professional.
10) The doctor listened to me and my problems and showed respect and concern for what I had to say.
11) The doctor explained things in a way I could understand.
12) The check out process was efficient.
13) I was satisfied with the service and the overall quality of my visit.

Comments

14) What did you like the most about your visit?
15) What did you like the least about your visit?
16) Other comments or suggestions?
17) Do we have your permission to contact you regarding this survey (Optional)?

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Join the new generation of patients taking a more active role in managing their health and wellness.

Access your personal medical records, communicate with your doctors via online messaging, and make more informed decisions about your health!

  • Review your visit summary
  • Send and receive secure messages
  • Request an appointment
  • Receive email care reminders
  • Update your health information

Have questions or would like to schedule an appointment?


2165 Little Rd, Trinity, FL 34655 | (727) 372-6637

Florida Joint Care Institute © 2017