Survey

Dear Patient: According to our records, you recently visited the provider named above. Please tell us your opinion about the service you received from this provider. Your responses will be kept strictly confidential. Thanks for your help.

PLEASE RATE THE FOLLOWING

A. YOUR APPOINTMENT
المواعيد الطبية

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

A. YOUR APPOINTMENT

1. Ease of making appointments by phone
سهولة الحصول على الموعد عبر الهاتف
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. Appointment available within a reasonable amount of time
تأمين الموعد خلال وقت قصير
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. Getting care for illness/injury as soon as you wanted it
تقديم الرعاية الطبية فور طلبها
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
4. Getting after-hours care when you needed it
الحصول على الرعاية الطبية حتى بعد ساعات العمل
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
5. The efficiency of the check-in process
فعالية التسجيل عند الحضور للموعد
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
6. Waiting time in the reception area
مدة الإنتظار في غرفة الإستقبال
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
7. Waiting time in the exam room
مدة الإنتظار في غرفة الفحص
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
8. Keeping you informed if your appointment time was delayed
إعلامك في حال تم تأخير الموعد
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
9. Ease of getting a referral when you needed one
سهولة الحصول على موعد المختص عند التحويل
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

B. OUR STAFF
طاقم العمل

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

B. OUR STAFF

1. The courtesy of the person who took your call
اهتمام الموظف الذي تلقى مكالمتك
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. The friendliness and courtesy of the receptionist
اهتمام وتعاون موظف الإستقبال
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. The caring concern of our nurses/medical assistants
رعاية واهتمام الممرضين والمساعدين الطبيين
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
4. The helpfulness of the people who assisted you with billing or insurance
مساعدة العاملين القائمين على الأمور المالية والتأمين الصحي
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
5. The professionalism of our lab or x-ray staff
كفاءة موظفي المختبر والتصوير الإشعاعي
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

C. OUR COMMUNICATION WITH YOU
عملية التواصل معكم

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

C. OUR COMMUNICATION WITH YOU

1. Your phone calls answered promptly
الإجابة على الإتصالات الهاتفية فور ورودها
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. Getting advice or help when needed during office hours
الحصول على المساعدة الطبية عند الحاجة إليها خلال ساعات العمل
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. Explanation of your procedure (if applicable)
الحصول على شرح وافي للعملية الجراحية
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
4. Your test results reported in a reasonable amount of time
الحصول على نتائج التحاليل خلال فترة زمنية معقولة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
5. Effectiveness of our health information materials
فعالية ودقة المعلومات الطبية لدينا
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
6. Our ability to return your calls in a timely manner
قدرة الإجابة على مكالمتك الهاتفية خلال فترة وجيزة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
7. Your ability to contact us after hours
القدرة على التواصل معنا بعد ساعات العمل
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
8. Your ability to obtain prescription refills by phone
قدرة إعادة تعبئة الوصفة الطبية عبر الهاتف
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

D. YOUR VISIT WITH THE PROVIDER
(Doctor, Physician Assistant, Nurse Practitioner)
ماذا عن الفريق الطبي

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

D. YOUR VISIT WITH THE PROVIDER
(Doctor, Physician Assistant, Nurse Practitioner)

1. Willingness to listen carefully to you
الرغبة بالإنصات إليك بعناية واهتمام
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. Taking time to answer your questions
اعطائك الوقت الكافي للإجابة على أسئلتك
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. Amount of time spent with you
هل يقضي الطبيب مدة كافية معك خلال الزيارة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
4. Explaining things in a way you could understand
شرح تفاصيل حالتك الطبية بصورة واضحة ومفهومة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
5. Instructions regarding medication/follow-up care
وضوح التعليمات الخاصة بالأدوية والمتابعة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
6. The thoroughness of the examination
النصائح والطرق المقدمة للحفاظ على الصحة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
7. Advice given to you on ways to stay healthy
هل كان هناك شرح مفصًل عن طرق للعناية بصحتك
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

E. OUR FACILITY
المرافق الطبية

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

E. OUR FACILITY

1. Hours of operation convenient for you
ساعات العمل مناسبة لك
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. Overall comfort
توفير الراحة الكاملة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. Adequate parking
توفير مواقف السيارات
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
4. Signage and directions easy to follow
سهولة متابعة اللافتات والإتجاهات
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

F. YOUR OVERALL SATISFACTION WITH
الإرتياح والرضا العام حول

Excellent
Very Good
Good
Fair
Poor
Does Not Apply

F. YOUR OVERALL SATISFACTION WITH

1. Our practice
المركز الطبي
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
2. The quality of your medical care
نوعية الرعاية الطبية المقدمة
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A
3. Overall rating of care from your provider or nurse
تقييم العناية المقدمة من الطبيب أو الممرض
5
Excellent
4
Very Good
3
Good
2
Fair
1
Poor
N/A
N/A

WOULD YOU RECOMMEND THE PROVIDER TO OTHERS?
هل تنصح المرضى الأخرين بالمتابعة والعلاج مع الطبيب المذكور أعلاه

  YES نعم    No لا
IF NO, PLEASE TELL US WHY
في حال إجابتك بلا، يرجى ذكر السبب

IF THERE IS ANY WAY WE CAN IMPROVE OUR SERVICES TO YOU, PLEASE TELL US ABOUT IT
أخبرنا إن كان هناك أية طريقة لتحسين خدماتنا المقدمة

SOME INFORMATION ABOUT YOU

Gender
الجنس

  MALE ذكر     FEMALE أنثى

YOUR AGE
العمر

ARE YOU
هل أنت؟

  a new patient مريض جديد     a returning patient مريض عائد للعلاج