Privacy Policy    

Patient Satisfaction Survey

Thank you for taking the time to respond. Your input is important to us.

1) I am treated courteously by the staff when I call in for an appointment.
 Always       Usually       Rarely       Never       Does not apply
2) I easily found my way to Legacy Heart Center.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
3) The availability of parking is adequate.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
4) I am greeted and treated courteously by the staff when I sign in for my appointment.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
5) If I have to wait in the lobby to be called back for my scheduled appointment, the wait is generally…
 Sooner than expected       What I expected       Longer than expected       Does not apply
6) If there is a delay in seeing the doctor once I am in an exam room, the delay is generally…
 Sooner than expected       What I expected       Longer than expected       Does not apply
7) An explanation is provided to me about any delays in my appointment.
 Always       Usually       Rarely       Never       Does not apply
8) I find the nursing staff willing to listen to my concerns and opinions about my medical condition.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
9) If necessary, the staff gave me a clear and complete explanation about the procedure or test that will be performed.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
10) If necessary, the nursing staff gave me a clear and complete explanation of the results of the procedure or test that was performed.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
11) The nursing staff is responsive to my requests and phone calls.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
12) The physician was willing to listen to my concerns and opinions about my medical condition.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
13) The physician gave me a clear and complete explanation about my medical condition and any treatment and/or testing if necessary.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
14) When I check out after my appointment, I find the staff helpful in assisting me with questions and/or scheduling additional appointments or testing if necessary.
 Always       Usually       Rarely       Never       Does not apply
15) I find the billing statement easy to understand.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
16) I receive a prompt response from the billing office if I have a question.
 Always       Usually       Rarely       Never       Does not apply
17) I receive courteous assistance from the billing office when I have a question.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
18) Overall, I am very satisfied with the quality of care and service I receive.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
19) I would be very likely to recommend Legacy Heart Center to family and friends.
 Agree Strongly       Agree       Disagree       Disagree Strongly       Does not apply
If you would like to make additional comments please do so in the space below.
To have our Patient Relations Representative contact you, please complete the information below.
Name:
Phone:
Email:
Your email address is required to submit the form.