Provider: Gary C. Bernard, MDLeiah Walrod, MD
1. Making your appointment:
a. Did you make an appointment request online? YesNo
b. If you did make an appointment request online, did you receive a phone call or email confirmation for your appointment? YesNo
c. Was the appointment coordinator friendly & courteous to you? YesNo
d. Were you asked the reason for your visit? YesNo
2. Check-In:
a. Was the check-in coordinator friendly & courteous to you? YesNo
b. Were there any problems checking in? YesNo
3. Was your MA helpful in the following areas:
a. Gathering information in regards to your visit? YesNo
b. Answering and/or being informative of your questions? YesNo
4. Your experience with the provider:
a. Did the provider listen to you? YesNo
b. Was the provider easy to talk to? YesNo
c. Did you understand your treatment? YesNo
d. Did you feel rushed by the provider? YesNo
e. Was the provider friendly & courteous to you? YesNo
f. Was the process of your visit properly explained where it made sense? YesNo
5. Check-Out:
a. Was a follow-up appointment made for you? YesNo
b. Was the check-out coordinator friendly & courteous to you? YesNo
6. If additional testing was done, were your questions answered? YesNo
7. If you were a new patient, did you get an exit interview with the customer service manager? YesNoI'm not a new patient
8. How would you rate your overall wait time? —ExcellentGoodAveragePoorFailing
9. Overall, how would you rate your experience at Pointe Med? —ExcellentGoodAveragePoorFailing
10. Please tell us if there was any part of your visit that met and/or exceeded your expectations:
11. Is there an employee that you would like to recognize as going above and beyond your expectations?
12. Do you have any other suggestions or comments that would help us make your visit to our office better?
