Patient Satisfaction Report Card

Help us provide you with the best possible care by responding to this short survey.

Which doctor did you see?

How did you hear about us? (Check all that apply)
NewspaperPhone BookAdvertisementInternet SiteInsurance DirectoryDoctor ReferralFriend/RelativeOther

If you were referred by another doctor, what is the name of that doctor?

Please rate your level of satisfaction in the following areas:

The doctor's explanation of your medical problem
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The amount of time the doctor spent with you
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The doctor's level of concern for you and your problem
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The ease of making an appointment
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The friendliness and courtesy shown by the front office staff
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The length of time waiting to be seen
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The ease of scheduling your surgery in the office
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The level of professionalism in handling phone calls
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

The overall care provided to you
Very satisfiedNeither satisfied nor dissatisfiedNot at all satisfied

How likely would you be to recommend Surgical Associates of West Florida to a friend?
Very likelyNo opinionNot at all likely

How can we improve our services in the future?

What is your age?
< 1818–6566 or older

Sex
MaleFemale