Patient Satisfaction Survey

This survey asks about today's visit and visits you have had to the Mankato Clinic in the past year. Please answer each question.

Patient Satisfaction Survey
What department were you seen in today?

What physician or practitioner did you see?
What was the date of your appointment?	(mm/dd/yyyy)
How would you rate your visit based on the following:
1. Ease and convenience in scheduling an appointment with the Mankato Clinic:	Excellent Very Good Good Fair Poor
2. Length of time to get an appointment:	Excellent Very Good Good Fair Poor
3. Convenience of Mankato Clinic Hours:	Excellent Very Good Good Fair Poor
4. Friendliness and courtesy of the staff:	Excellent Very Good Good Fair Poor
5. Satisfaction with facility and medical equipment used:	Excellent Very Good Good Fair Poor
6. The visit overall:	Excellent Very Good Good Fair Poor
Physician or Practitioner Satisfaction:
1. Quality of care provided by the physician or practitioner:	Excellent Very Good Good Fair Poor
2. Communication with physician or practitioner:	Excellent Very Good Good Fair Poor
3. Education provided to help you improve your health & stay healthy:	Excellent Very Good Good Fair Poor
4. Information from tests relayed in a timely manner:	Excellent Very Good Good Fair Poor
5. How would you rate the coordination of your follow up care:	Excellent Very Good Good Fair Poor
6. Would you recommend this physician or practitioner?	Definitely Yes Probably Yes Probably Not Definitely Not
7. Would you recommend the Mankato Clinic to others?	Definitely Yes Probably Yes Probably Not Definitely Not
Comments: We welcome your input. (if you input comments, your name and phone number are required.)

Your Name:
Your Phone:

Patient Satisfaction Survey

How would you rate your visit based on the following:

Physician or Practitioner Satisfaction:

Comments: