Which Provider did you visit? *
Lisa Tallet, P.A.
Sarah A. Glantz, PA-C
I made my appointment by:
During my last visit
Through my Primary Care Physician
When was the first available appointment when you were scheduling your appointment?
Less than 24 hours
1 - 2 days
3 - 4 days
5 - 6 days
7 - 8 days
It was easy to schedule my appointment.
The person who scheduled my appointment was respectful and friendly.
My phone calls were answered in a timely manner.
I was quickly directed to the person that could answer the question.
Comments regarding your scheduling?
Speed of the Registration Process?
Courtesy of staff in the registration area?
Comfort and pleasantness of the waiting area?
Length of wait before going to exam room.
How would you rate the customer service provided at check-in/registration?
Comments regarding your registration?
DURING YOUR VISIT
The nurse/assistant was friendly and courteous.
The nurse/assistant expressed concern for your problem.
The waiting time in the exam room before being seen by a care provider was acceptable.
The answers / information / instructions provided to me by the nurse were helpful.
Comments regarding your visit?
Who provided your primary care?
Physician Assistant (P.A.)
Nurse Practitioner (N.P.)
YOUR CARE PROVIDER
Friendliness/Courtesy of the care provider?
Explanations the care provider gave you regarding your problem or condition?
Concern the care provider showed for your question or worries?
Care provider's efforts to include you in decisions about your treatment?
Information the care provider gave you about medications (if any)?
Instructions the care provider gave you about follow-up care?
Degree to which care provider talked with you using words you could understand?
Amount of time the care provider spent with you?
Your confidence in this care provider?
Likelihood of your recommending this care provider to others?
Comments regarding your care provider?
If I had to leave a message, my phone call was returned in a timely manner.
It was easy to place a prescription refill over the phone.
Comments regarding your phone experience?
If you had to leave a message, how long did you have to wait for a return call?
Less than 1 hour
1 - 3 hours
4 - 8 hours
1 - 2 days
QUESTIONS REGARDING YOUR BILL
Was your billing statement easy to read?
If you had to contact the Billing/Collection Department, were they helpful in answering your questions?
Were the payment options listed on the statement clear?
Comments regarding personal issues or billing
Overall cheerfulness of our Practice?
Overall cleanliness of our Practice?
Overall rating of care received during your visit?
Likelihood of your recommending our Practice to others?
Convenience of our office hours?
Our sensitivity to your needs?
Our concern for your privacy?
Comments regarding the overall practice?
Patient's Name (optional)
Patient's Telephone Number (optional)
Would you like someone to contact you regarding this survey?
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