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SATISFY Patient Satisfaction Survey

Our practice strives to deliver the highest quality health care services in a professional and caring way. Your feedback on our services is valued. Please take about 5 minutes to complete questions pertaining to the doctors, technicians, front desk staff, and office. The survey is anonymous and the data is stored securely in the cloud.

Please rate the following statements from 1 to 5 (or in some instances "N/A") for :

Please rate the following statements from 1 to 5 (or in some instances "N/A") for :

Please rate the following statements from 1 to 5 (or in some instances "N/A") for :

main

Locate

Locate

1. Which location did you visit?

New York City

Long Island

2. Which provider did you see today?

Dr. Gentile

Dr. Silva

Dr. Parikh

Dr. Reppucci

1. Dr. smiled and made me feel welcome.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

2. Dr. treated and addressed me as a person, not a number or medical diagnosis.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

3. Dr. was respectful of my time.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

4. Dr. respected and was sensitive to my cultural background. If not applicable to your visit, please select "N/A."

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

N/A

5. Dr. was empathetic (and understood me).

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

6. Dr. was friendly.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

7. Dr. addressed all my concerns.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

Thank you for your feedback

8. How satisfied were you with Dr. today?

1 (Very Unsatisfied)

2 (Unsatisfed)

3 (Neutral)

4 (Satisfied)

5 (Very Satisfied)

9. On a scale of 1-10, how likely is it that you would recommend Dr. to someone else?

1

2

3

4

5

6

7

8

9

10

(Not Likely At All)

(Neutral)

(Extremely Likely)

10. What is the primary reason for your score in the two previous questions?

11. Additional comments, feedback, or concerns for Dr. :

Which technician helped you today?

Catalina

Sophie

Nervanie

Jennifer

Kemi

Himani

Destiny

Naomi

Julia

Stephen

Rishi

Alex

Nya

SKIP

1. smiled and made me feel welcome.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

2. treated and addressed me as a person, not a number or medical diagnosis.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

3. was respectful of my time.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

4. respected and was sensitive to my cultural background. If not applicable to your visit, please select "N/A."

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

N/A

5. was empathetic (and understood me).

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

6. was friendly.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

7. addressed all my concerns.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

8. How satisfied were you with today?

1 (Very Unsatisfied)

2 (Unsatisfed)

3 (Neutral)

4 (Satisfied)

5 (Very Satisfied)

9. On a scale of 1-10, how likely is it that you would recommend to someone else?

1

2

3

4

5

6

7

8

9

10

(Not Likely At All)

(Neutral)

(Extremely Likely)

10. What is the primary reason for your score in the two previous questions?

11. Additional comments, feedback, or concerns for :

1. Which member of the front desk helped you today?

Alice

Evangeline

Giselle

Jennifer

Tamjid

Mylana

SKIP

1. smiled and made me feel welcome.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

2. treated and addressed me as a person, not a number or medical diagnosis.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

3. was respectful of my time.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

4. respected and was sensitive to my cultural background. If not applicable to your visit, please select "N/A."

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

N/A

5. was empathetic (and understood me).

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

6. was friendly.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

7. addressed all my concerns.

1 (Strongly Disagree)

2 (Disagree)

3 (Neutral)

4 (Agree)

5 (Strongly Agree)

8. How satisfied were you with today?

1 (Very Unsatisfied)

2 (Unsatisfed)

3 (Neutral)

4 (Satisfied)

5 (Very Satisfied)

9. On a scale of 1-10, how likely is it that you would recommend to someone else?

1

2

3

4

5

6

7

8

9

10

(Not Likely At All)

(Neutral)

(Extremely Likely)

10. What is the primary reason for your score in the two previous questions?

11. Additional comments, feedback, or concerns for :

1. On a scale of 1-10, how likely is it that you would recommend Gentile Retina to someone else?

1

2

3

4

5

6

7

8

9

10

(Not Likely At All)

(Neutral)

(Extremely Likely)

2. What is the primary reason for your score to the previous question?

3. How satisfied were you with Gentile Retina today?

1 (Very Unsatisfied)

2 (Unsatisfed)

3 (Neutral)

4 (Satisfied)

5 (Very Satisfied)

4. Is there anything you would change about your experience?

Office 4

Release 1.0