Satisfaction Survey

Your opinion and feedback are important to us...

Si desea llenar este cuestionario en Español visite.

Dear Valued Patient,

On behalf of the Pinnacle HealthCare staff, we would like to thank you for choosing our medical clinic. Our goal is to provide each and every patient with the highest level of medical care and service.

Please take a few minutes to complete the patient satisfaction survey. Your input, suggestions and recommendations will help us to make improvements, to better serve your needs. We look forward to your feedback and greatly value your opinion.

Thank you very much for taking time to share your thoughts and perspective with us.

Sincerely,

M. Bruce Carter, MD
Medical Director

BACKGROUND QUESTIONS
1. Date of Visit.
2. Clinic Name
Hollister King City Los Banos Salinas-Blanco Salinas-Rossi Watsonville Yuma
3. Name of Doctor/Medical Provider that treated you.
4. How did you hear about our clinic?
Advertising (Newspaper, Phonebook) Convenient Location Referred by Family/Friend Referred by Employer
5. Which type of treatment did you receive? (You may choose more than one.)
Illness Injury Work related injury Other
6. How long did you have to wait to see the health care provider?
Less than 30 minutes 30 minutes to 60 minutes More than 60 minutes

REGISTRATION/RECEPTION
	Excellent	Good	Fair	Poor
Ease of scheduling appointment
Registration procedure
Professionalism/courtesy of reception staff
Helpfulness on the telephone
Comfort & cleanliness of the waiting area
Insurance and billing process

MEDICAL VISIT
	Excellent	Good	Fair	Poor
Professionalism/courtesy of medical staff
Comfort and cleanliness of exam room
Concern the medical staff showed for your condition
Waiting time in exam room before being seen by health care provider
Thoroughness of exam and accuracy of diagnosis
Explanation of lab or x-ray results
Time spent by the health care provider
Quality of medical care
Explanation of Follow-up instructions
Explanation and instructions about medications
Likeliness of your recommending this health care provider to others
Overall satisfaction with Medical Care
Comments:

GENERAL ASSESSMENT
	Excellent	Good	Fair	Poor
Convenience of office hours
Convenience of parking
Efficiency and accuracy of billing system
Overall satisfaction with Pinnacle Urgent Care
Would you recommend Pinnacle HealthCare to your co-workers or family members? YES NO
Additional Comments:

Optional
Name:
Home Phone:
Address:
City:
Zip Code:
Would you like to follow up correspondence or phone call to discuss your visit or other issues? YES NO

Security Code: