Patient Visit Survey

Visiting the doctor isn’t always fun, but we want to make it the best experience possible. Your feedback is very important to us.

Patient Visit Survey

  • Well child visitFollow up visitSick visit
  • Extremely easyVery easyModerately easySlightly easyNot easy at all
  • Extremely friendly and helpfulVery friendly and helpfulModerately friendly and helpfulSlightly friendly and helpfulNot friendly or helpful
  • Extremely friendly and courteousVery friendly and courteousModerately friendly and courteousSlightly friendly and courteousNot friendly and courteous at all
  • Extremely wellVery wellModerately wellSlightly wellNot well at all
  • Less than 15 minutes15 - 30 minutesMore than 30 minutes
  • Extremely helpful and supportiveVery helpful and supportiveModerately helpful and supportiveSlightly helpful and supportiveNot at all helpful and supportiveNot applicable
  • Extremely wellVery wellModerately wellSlightly wellNot well at all
  • Extremely pleasedVery pleasedModerately pleasedSlightly pleasedNot pleased at all
  • YesMaybeNo
  • This field is for validation purposes and should be left unchanged.

Encuesta de Visita para el Paciente

  • Visita preventiva de bienestarVisita de seguimientoVisita de enfermedad
  • Extremadamente fácilMuy fácilBastante fácilUn poco fácilPara nada fácil
  • Extremadamente amable, atentos, y servicialesMuy amable, atentos, y servicialesBastante amable, atentos, y servicialesUn poco amable, atentos, y servicialesNada amable, atentos, y serviciales
  • Extremadamente amable y atentaMuy amable y atentaBastante amable y atentaUn poco amable y atentaNada amable y atenta
  • Extremadamente bienMuy bienBastante bienNo tan bienMal
  • Menos de 15 minutos15 - 30 minutosMas de 30 minutos
  • Extremadamente atento/a y comprensivo/aMuy atento/a y comprensivo/aBastante atento/a y comprensivo/aUn poco atento/a y comprensivo/aNada atento/a y comprensivo/aNo corresponde
  • Extremadamente bienMuy bienBastante bienUn poco bienPara nada bien
  • Extremadamente satisfechoMuy satisfechoBastante satisfechoUn poco satisfechoNada satisfecho
  • Tal vezNo
  • This field is for validation purposes and should be left unchanged.