karande_logo
 
homeUP
meetUP
whatUP
testingUP
treatmentUP
maleUP
embryologyUP
successUP
donorUP
insuranceUP
sharedUP
schedulingUP
locationsUP
articlesUP
emailUP

 
PATIENT SATISFACTION QUESTIONNAIRE/SURVEY

We are listening!

One of the many goals of Karande and Associates is to make your experience with us a pleasant one, while providing excellent care in a compassionate and professional environment. To help us continue to do this and also improve those services provided, we encourage you to fill out this survey. The physicians and staff appreciate your comments/suggestions and the opportunity to enhance yours and others experience with us.

Please note your feedback will be kept confidential unless you wish to provide your name and email at the end of the questionnaire.








Environment (Please circle)
Rate Excellent=5 Poor=1
1. Was the waiting room area comfortable? 1 2 3 4 5
2. Were the dressing & recovery rooms comfortable? 1 2 3 4 5
3. Was the clinical setting pleasant? 1 2 3 4 5
4. Was the length of time spent in the waiting room reasonable? 1 2 3 4 5
Comments


Locations
Rate Excellent=5 Poor=1
5. Convenience of office locations. 1 2 3 4 5
6. Convenience of office hours. 1 2 3 4 5
7. How often have you been to our office? < 6 times > 6 times
8. Office location: Hoffman Estates
Arlington Heights
St. Charles
Park Ridge
9. Did you use multiple locations? YES NO


Scheduling Process (Please circle)
Rate Excellent=5 Poor=1
10. Ease in getting an appointment scheduled. 1 2 3 4 5
11. Was the registration process simple, fast, and complete? 1 2 3 4 5
12. Were paperwork/forms easy to understand? 1 2 3 4 5
13. Did the reception staff verify your contact and insurance information prior to your scheduled appointment? 1 2 3 4 5
14. Did you feel that your information was treated as confidential? 1 2 3 4 5
15. Responsiveness and friendliness of receptionists to phone requests. 1 2 3 4 5
16.







When you called the office, were the telephone auto directory options communicated clearly?

Did you use the options?

For Emergencies was it clearly communicated how to reach the nurse/physician?

1 2 3 4 5

YES NO

YES NO
17. Was the reception staff helpful, and capable? 1 2 3 4 5
18. Scheduled appointment date/time was maintained? 1 2 3 4 5
19. Was it easy to make follow-up visits? 1 2 3 4 5
20. Were you treated with courtesy while in the waiting area? 1 2 3 4 5
Comments


Education/Communication (Please circle)
Rate Excellent=5 Poor=1
21. Which physician was your primary contact? 1 2 3 4 5
22. When you asked questions did the physician provide answers in a way that you understood? 1 2 3 4 5
23. Did your physician explain the tests you needed and what these tests would indicate, in a way that you understood? 1 2 3 4 5
24. Did you spend as much time with your physician as you wanted? 1 2 3 4 5
25. Did the clinical staff present information regarding your next appointment, tests required and/or medication prescribed clearly? 1 2 3 4 5
26. Did the clinical staff answer your questions and provide education in a manner that you understood? 1 2 3 4 5
27. Were you provided with as much information about your condition and treatment as you wanted/needed? 1 2 3 4 5
28. Were your phone calls/results returned to you promptly? 1 2 3 4 5
29. Was the PRN phone system convenient and user friendly? 1 2 3 4 5
30. If you had IVF, was the information given to you by embryology regarding your cycle, explained to your satisfaction and understanding? 1 2 3 4 5
Comments


Professionalism (Please circle)
Rate Excellent=5 Poor=1
31. Did you have confidence and trust in your physician? 1 2 3 4 5
32. Did your physician conduct him/herself in a professional manner? 1 2 3 4 5
33. Did clinical staff express interest/support to both you and your partner? 1 2 3 4 5
34. Was the clinical staff friendly and professional? 1 2 3 4 5
35. Overall, do you feel you were treated professionally during your visit? 1 2 3 4 5
36. Would you recommend Karande & Associates to family or friends? 1 2 3 4 5
37. If you had IVF was the RN. Anesthetist informative and professional? 1 2 3 4 5
Comments


Billing/Customer Service (Please circle)
Rate Excellent=5 Poor=1
38. Was our customer service department able to assist you in any billing issues/questions you may have had? 1 2 3 4 5
Comments
39. What was the outcome of your treatment? Pregnancy
Pregnancy with live birth
Second Opinion
Discontinued treatment
May we contact you for clarification on your comments? YES NO
Name (optional)
EMail (optional)  



© 2004 Karande & Associates, S.C. | Terms of Use