Patient Satisfaction Survey: Outpatient Clinic Visit

We are interested in your feedback about the services we provide so that we can make improvements. Here are some questions about the visit you just made to the Outpatient Clinic. Your answers are anonymous and confidential. To ensure your survey counts, please answer each question. Date: (year/month/day)_____________________. In terms of your satisfaction, how would you rate each of the following?
(Circle one number in each line)		Excellent	Very Good	Good	Fair	Poor
1.	Getting through to the Outpatient Clinic by phone—□ Not Applicable	1	2	3	4	5
2.	Length of time waiting once you arrived for your appointment	1	2	3	4	5
3.	Time spent with the healthcare providers you saw in Clinic for your review	1	2	3	4	5
4.	Answers to your questions	1	2	3	4	5
5.	Explanation of the results of the assessment	1	2	3	4	5
6.	Advice and information about exercise and returning to activities	1	2	3	4	5
7.	The technical skills (thoroughness, carefulness, competence) of the healthcare providers you saw in Clinic for your review	1	2	3	4	5
8.	The personal manner (courtesy, respect, sensitivity, friendliness) of the healthcare providers you saw in Clinic for your review	1	2	3	4	5
9.	The visit overall	1	2	3	4	5

Adapted from GHAA/Davies & Ware (1991)