Patient Satisfaction Survey Direct feedback helps us continuously improve patient care and other services. We appreciate you taking the time to complete this Patient Satisfaction Survey. Location:*Ashland Medical CenterCold Harbor Family MedicineHanover Family PhysiciansInnsbrook Primary CareLaboratory ServicesMedical Specialists Division: RheumatologyMidlothian Family Practice: Village OfficeMidlothian Family Practice: Waterford OfficeMidlothian Family Practice: Powhatan OfficeMidlothian Family Practice: Westchester OfficeMidlothian Medical Care - WadsworthReynolds Primary Care(Where was your appointment ? )You are a :New PatientExisting PatientThe date of your appointment was :Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your appointment was with Dr. Please rate the statements below using the following scale: 1 = Very Dissatisfied 2 = Somewhat Dissatisfied 3 = Somewhat Satisfied 4 = Very Satisfied NA = Not ApplicableWHEN SCHEDULING YOUR APPOINTMENT...1234NA1.Telephone answered promptly2.Courteous and caring attitude of staff scheduling appointment3.Convenience of appointment time4.Convenience of the location5.Directions to office offered6.You Received a call from the office reminding you of this appointmentComments:REGISTRATION AND CHECK OUT PROCESS?1234NA1.Ease of parking and access to the building2.Prompt check-in process3.Courteous and caring check-in staff4.Effectiveness of check-in staff in handling registration5.Follow-up appointment handled efficiently6.Co-pay and insurance issues handled efficiently7.Effectiveness of handling referral request8.Courteous and caring attitude of referral coordinatorComments:YOUR EXAM AND CARE...1234NA1.Wait time before being seen by clinician/physician2.Courteous and caring attitude of clinical staff (nurses, lab techs, x-ray techs)3.Courteous and caring attitude of physician4.Physician explained medical issues thoroughly5.Understanding of your condition after your visit6.Environment pleasant and clean7.Educational materials presented to you regarding your conditionComments:ACCOUNTING/BILLING...1234NA1.Courteous and caring attitude of billing staff2.Billing questions were explained thoroughly3.Billing inquires left on voice mail were returned with in 24 - 48 hours or 1 - 2 business daysYOUR OVERALL EXPERIENCE...YesNo1.Would you return to Virginia Physicians, Inc.?2.Would you recommend Virginia Physicians, Inc. to your family and friends?REQUIRED CONTACT INFORMATION1.Name:2.Contact number:3.Best time of the day to reach you:NameThis field is for validation purposes and should be left unchanged.
