Patient Satisfaction Survey

Patient satisfaction is our number one goal

Dear Patient:

Our goal is to provide comfort, convenience, and satisfaction as well as the very best medical care to all our patients. We would like to know how you feel about our medical services. Your comments will help us assure that we are truly responsive to your needs.

Thank you for your help.

For us to better understand your experience with NOHC and OMG please provide the following information:
Title	First Name *	Last Name *

Date of Service	Email *	Phone Number

Address

City	State	Zip Code

Please enter word verification*

A. Your Appointment	Excellent	Very Good	Good	Fair	Poor	N/A
Ease of making appointments by phone
Appointment available within a reasonable amount of time
Waiting time in the reception area
Keeping you informed if your appt time was delayed
B. Our Staff	Excellent	Very Good	Good	Fair	Poor	N/A
The courtesy of the person who took your call
The friendliness and courtesy of the receptionist
The caring concern of our nurses/medical assistants
C. Our Communication With You	Excellent	Very Good	Good	Fair	Poor	N/A
Your phone calls answered promptly
Getting advice or help when needed during office hours
Your test results reported in a reasonable amount of time
Your ability to contact us after hours
Your ability to obtain prescription refills by phone
D. Your Visit with the Doctor or Nurse Practitioner	Excellent	Very Good	Good	Fair	Poor	N/A
Willingness to listen carefully to you
Taking time to answer your questions
Explaining things in a way you could understand
E. Your Overall Satisfaction With	Excellent	Very Good	Good	Fair	Poor	N/A
Our practice
The quality of your medical care
Overall rating of care from your provider
Which Provider did you see?
If there is any way we can improve our services to you, please tell us:

Patient Satisfaction Survey

Patient satisfaction is our number one goal

For us to better understand your experience with NOHC and OMG please provide the following information: