Neurology Consultants of Dallas

Neurology Consultants of Dallas
Patient Satisfaction Survey

At Neurology Consultants of Dallas our goal is to provide courteous, caring service for all of our patients. Please let us know how we're doing.
Date of Office Visit:   

Physician Who Treated You:   

Please respond to each of the following statements on a scale from
1 (not satisfied) to 5 (completely satisfied).
OFFICE ENVIRONMENT
1) I find your telephone system easy-to-use
1    2    3    4    5
2) It is easy for me to get to the person I need to speak to using the phone system
1    2    3    4    5
3) Hold time on the phone
1 minute or less   1 to 2 minutes   More than 2 minutes
4) My questions are answered by the first person who picks up the phone
Always   Generally   Occasionally   Never
5) I am frequently transferred to several people in the office before getting to the person who can answer my question
Always   Generally   Occasionally   Never
6) Wait time in the waiting room
Less than 5 minutes   5 to 10 minutes   More than 10 minutes
7) Wait time in the exam room
Less than 5 minutes   5 to 10 minutes   More than 10 minutes
8) Cleanliness of Neurology Consultants of Dallas office
1    2    3    4    5
9) Office environment made me feel comfortable
1    2    3    4    5
10) Friendliness/Personal Manner of Staff
1    2    3    4    5
FRONT OFFICE STAFF
11) Front desk staff greeted me promptly with a smile
1    2    3    4    5
12) Capability of staff to resolve problems on the telephone without multiple call transfers
1    2    3    4    5
NURSING STAFF
13) Phone messages are returned the same day and/or urgent messages are returned promptly
1    2    3    4    5
14) Capable of giving instructions for follow-ups and testing procedures
1    2    3    4    5
BILLING DEPARTMENT
15) Billing Department is able to answer questions regarding my statement
1    2    3    4    5
16) Calls regarding collection of outstanding account balances are handled with courtesy and professionalism
1    2    3    4    5
MRI DEPARTMENT
17) My appointment was on time
1    2    3    4    5
18) MRI Staff were able to explain my procedure to me thoroughly
1    2    3    4    5
19) Ability to answer questions
1    2    3    4    5
20) I was put at ease and made comfortable by the staff
1    2    3    4    5
PHYSICIANS
Your Physician:   

21) My appointment was on time
Yes    No
22) Are you a new patient or a follow-up patient?
New Patient    Follow-up Patient
23) Amount of time Physician spent with you
1    2    3    4    5
24) Explanation of care and treatment plan
1    2    3    4    5
OVERALL IMPRESSION
25) Your overall impression of your visit to our office
1    2    3    4    5
26) Would you recommend our office to family and friends?
1    2    3    4    5
Your comments are greatly appreciated and help us determine how we can best provide quality service for our patients. Please use the space below for additional comments.
Name (optional):   

You may also print this form, complete and mail it to:

Neurology Consultants of Dallas
7515 Greenville Ave., Suite 400
Dallas, TX 75231
Tel: 214.750.9977
Fax: 214.750.9983
Please print clearly.

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