Stony Brook Vein Center Patient Survey

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Name:

First:

Last:

Type of procedure:

Physician who attended to you:

Thinking about your visit with the physician or healthcare professional you saw, how would you rate the following

Questions	Poor	Fair	Good	Very good	Excellent
Ease of making an initial appointment	Poor	Fair	Good	Very good	Excellent
Was staff courteous and helpful on the phone?	Poor	Fair	Good	Very good	Excellent
Did you wait long for an appointment?	Poor	Fair	Good	Very good	Excellent
Convenience of the office location and parking	Poor	Fair	Good	Very good	Excellent
Were the forms you filled out easy to understand?	Poor	Fair	Good	Very good	Excellent
Was the reception area and receptionist welcoming?	Poor	Fair	Good	Very good	Excellent
Were you seen in a timely manner?	Poor	Fair	Good	Very good	Excellent
Did the doctor listen to your concerns?	Poor	Fair	Good	Very good	Excellent
Was the procedure and risks explained to you fully?	Poor	Fair	Good	Very good	Excellent
Were you told what to expect from the procedure?	Poor	Fair	Good	Very good	Excellent
Were your questions answered fully?	Poor	Fair	Good	Very good	Excellent
Were any concerns you had addressed?	Poor	Fair	Good	Very good	Excellent
Was the procedure performed satisfactorily?	Poor	Fair	Good	Very good	Excellent
Are you happy with the results?	Poor	Fair	Good	Very good	Excellent

Rate the personal manner (respect, courtesy, sensitivity, friendliness) of:

Questions	Poor	Fair	Good	Very good	Excellent
the Physician	Poor	Fair	Good	Very good	Excellent
the Nursing staff	Poor	Fair	Good	Very good	Excellent
the Reception staff	Poor	Fair	Good	Very good	Excellent

Comments:

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