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Please take a moment to rate the
quality of our service,
so we can better meet your needs		 1 = Very Satisfied
5 = Very Dissatisfied
   
Phone Calls  
How would you rate our phone system?... 1 2 3 4 5
   
Scheduling  
Have you found us accommodating to your medical needs?... 1 2 3 4 5
   
Were you able to get the appointment time you wanted?... 1 2 3 4 5
   
Were you able to get the Physician you wanted?... 1 2 3 4 5
   
Would you be interested in extended hours? (Please rank in order of preference.)
1 = best 5 = worst
Morning Lunch Evening
Saturday Morning Other
   
If you had surgery, did you find the person scheduling your surgery to be:  
professional? 1 2 3 4 5
friendly? 1 2 3 4 5
helpful? 1 2 3 4 5
   
Appointment  
Was the wait time in the Waiting Room reasonable?... 1 2 3 4 5
Was the wait time in the Exam Room reasonable?... 1 2 3 4 5
   
Office  
Was our office clean and comfortable?... 1 2 3 4 5
Is our office location convenient?... 1 2 3 4 5
Was the parking availability suitable to your needs?.. 1 2 3 4 5
   
Front Office and Business Personnel
Did you find our front office receptionists:  
professional? 1 2 3 4 5
friendly? 1 2 3 4 5
helpful? 1 2 3 4 5
   
Did you find our business office (insurance, billings and collections) personnel:  
professional? 1 2 3 4 5
friendly? 1 2 3 4 5
helpful? 1 2 3 4 5
   
When checking out, did you find the office staff:  
professional? 1 2 3 4 5
friendly? 1 2 3 4 5
helpful? 1 2 3 4 5
   
Nursing Staff  
Did you find the nursing staff to be:  
professional? 1 2 3 4 5
caring? 1 2 3 4 5
helpful? 1 2 3 4 5
   
Did the nurse return your call promptly?... 1 2 3 4 5
   
Physicians  
Did you find your physician to be:  
professional? 1 2 3 4 5
informative? 1 2 3 4 5
caring? 1 2 3 4 5
   
Did your physician spend enough time with you?... 1 2 3 4 5
   
Did your physician answer all of your questions?... 1 2 3 4 5
   
Overall Experience/Satisfaction
How would you rate our:  
facilities? 1 2 3 4 5
employees? 1 2 3 4 5
service? 1 2 3 4 5
   
What did you like best about Central Texas ENT?  
   
What did you like least about Central Texas ENT?  
   
Would you recommend Central Texas ENT to a relative or friend?... Yes No
   
Can we contact you regarding your responses? Yes No
   
Patient Demographics  
Age: Infant-4yrs old 5-10 11-15 16-25 26-40
         41-55 56-74 75+
 
Sex: Male Female
 
How were you referred to our office and by whom?
 
Comments:

 

 

*Any information contained within this website
does not substitute for a visit to your physician.