Patient Satisfaction Survey

Dear Patient;

Please take a few minutes to respond to this questionnaire by clicking on 1 if you are were highly dissatisfied and 5 if you were highly satisfied. My staff and I strive constantly to improve our performance. Your input will be highly valued. We would be happy to respond directly to any suggestions you may have. If you wish us to, please provide us with:

Your name:
Your email: (Not required)
  1. The office visit was worth my time and effort:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  2. The office staff were courteous and accomodating:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  3. Dr. Balaa and his staff were caring and genuinely interested in helping me with my medical issues:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  4. I was given adequate time to explain my condition and for my questions to be answered:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  5. I would like to make the following recomendations to improve the office visit:
  6. I was advised to visit our website 'www.GutCare.com' for detailed instructions and additional information about my condition.
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  7. I would like to make the following recomendations to improve the website 'www.GutCare.com':
  8. The endoscopic procedure was scheduled because (please circle applicable statements):
    I have a family history of colon cancer or colon polyps.
    I had colon polyps removed in the past
    I am having symptoms.
    I was concerned about colon cancer.
    I am at an age to requre a screening colonoscopy and this was my first.
  9. I was provided with sufficient explanation to lessen my anxiety about the procedure.
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  10. I did read the material on www.GutCare.com about how to render the preparation a little easier and found the information helpful:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  11. The staff in Dr. Balaa’s office were professional yet courteous, understanding and caring:
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  12. The procedure was free of significant discomfort.
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  13. The whole experience was worthwhile
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
  14. I will recommend Dr. Balaa and his staff to friends and family.
    0    1    2    3    4    5   
    Strongly Disagree Strongly Agree
How can we improve on the endoscopic experience?
Were there any individuals who stood out?
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