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Gentle Foot Care Survey

Home/Gentle Foot Care Survey

Please take a few minutes to fill out this survey on the timeliness and quality of the service you received today. Gentle Foot Care welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

ONE ANSWER PER SURVEY QUESTION PLEASE.

How long have you been a patient at our clinic?

Less than 6 months 6 months to a year 1-2 years 3 years +

How would you rate your overall experience?

Outstanding Good Adequate Needs Improvement Poor N/A

How often have you visited within the past year?

First Visit? 2-5 Visits? More than 6?

How did you schedule your appointment?

Scheduled by phone Dropped in Emailed

Was the person who scheduled your appointment courteous and helpful?

Very Courteous Courteous Somewhat Courteous Somewhat Rude Rude Very Rude

How long did you wait in the reception area beyond your scheduled appointment time?

0 to 5 minutes 5 to 20 minutes 20 to 40 minutes More than 40 minutes

How long did you wait in the exam room before the physician appeared?

0 to 5 minutes 5 to 20 minutes 20 to 40 minutes More than 40 minutes

How would you rate the competence of the assistant who helped you?

Outstanding Good Adequate Needs improvement Poor N/A

How would characterize the concern that the assistant showed for your problem?

Outstanding Good Adequate Needs improvement Poor N/A

Did you feel that your doctor spent an adequate amount of time with you?

Yes No N/A

Did you feel that your doctor’s examination was thorough?

Yes No N/A

Please rate the clarity of the doctor’s explanation of your condition and treatment options:

Outstanding Good Adequate Needs improvement Poor N/A

How well did your doctor include you in healthcare decisions?

Outstanding Good Adequate Needs improvement Poor N/A

Were your questions answered to your satisfaction?

Yes No N/A

Would you recommend this facility and its staff to your family and friends?

Yes No N/A

Please list any areas in which our service could be improved.

Please share any additional comments.

First and Last Name

Email Address

Phone Number

Thank you for taking the time to fill out our survey. We rely on your feedback to help us improve our services. Your input is greatly appreciated.

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