419.473.3561800.444.3561
Main Campus4235 Secor RoadToledo, Oh 43623
View our satellite locations
Contact Us > Patient Satisfaction Survey
Thank you taking a few minutes to complete this survey. We value your input.
Appointment Date:
Physician Name: Please Choose
Physician Location: Please Choose A Physician
1. What is your age? (If completing this questionnaire on behalf of your child's visit, select your child's age)
2. In comparison with other types of services that you have had a positive experience with that take reservations (such as a restaurant or hotel), how would you rate the courtesy provided by this office?
3. When you arrive at this office for your (your child's) appointment, how long do you usually have to wait in the waiting room before you are taken to an exam room?
4. Once in the exam room, how long do you usually wait before the Doctor comes in to see you?
5. When calling for medical information or advice, how long does it usually take for this Doctor's office to return your call during office hours?
6. Please rate your overall satisfaction with your ability to access care as a Toledo Clinic patient.
7. Please rate this Doctor's Office Staff on the following:
a. The friendliness and courtesy they show you (your child)
b. Making you (your child) feel valued and important during your visit
c. The attention given to your (your child's) privacy
d. Your ability to get through on the telephone
e. How helpful they are in arranging appointments with the Doctor
f. Providing you with easy access to the Doctor when needed
8. Please rate this Doctor's MA or Nurse on the following:
a. The professionalism of the MA or nurse
b. Reassurance and support offered by the MA or Nurse
c. The amount of time the MA or Nurse spends with you (your child)
d. The technical skills of the MA or Nurse
e. How knowledgeable the MA or Nurse is in answering questions
9. Please rate the Doctor on the following:
a. The amount of time the Doctor spends with you (your child)
b. The thoroughness in which the Doctor examines you (your child)
c. Allowing you to fully explain how you (your child) are feeling
d. How well the Doctor listens to what you have to say
e. The friendliness and courtesy the Doctor shows you (your child)
f. The professional manner of the Doctor
g. Reassurance and support offered to you (your child) by the Doctor
h. How well the Doctor explains the purpose, dosage and side effects of medication prescribed
i. How promptly the office follows up with you to give you the results of blood tests, x-rays or other tests the Doctor ordered
j. How well the Doctor explains test results, treatment procedures, and makes recommendations
k. How well the Doctor explains test results, treatment procedures, and makes recommendations
10. If you (your child) saw a Specialist, how long did it take to get in for your first appointment?
11. Did you (your child) have a surgical procedure performed by the specialist you are evaluating today?
12. How would you rate how well the Doctor and his staff coordinated this surgical experience for you (your child), for example explaining pre and postoperative expectations, scheduling the surgical procedure and tests, and follow-up with care in the office after the procedure?
13. How would you rate your overall satisfaction with the Doctor you have evaluated today?
14. Would you refer someone close to you to the physician you've evaluated today?
15. Please tell us what you liked best about this physician's practice.
16. What would you like to see this physician change or improve to deliver a better overall experience to you?
17. Do you have any additional comments? All comments are anonymous. Your name is not associated with these comments or any of your answers in this questionnaire. Please list any additional comments below.
