Karen Stanek MD, PHD
Michael Keith ARNP
Drew Johnson PA
Patricia Hines ARNP

(509) 624 - 0908

Patient Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. Thank you for your time!

Fill out the electronic form below or click the Download button, print, and fill out the paper survey.

Electronic Patient Survey

From the time of your appointment, how long did you wait until you were placed in an examination room?

0 - 5 Minutes
6 - 15 Minutes
16 - 30 Minutes
31 - 60 Minutes
>60 Minutes

From the time you were placed in an examination room, how long did you wait until the Provider entered the room?

0 - 5 Minutes
6 - 15 Minutes
16 - 30 Minutes
31 - 60 Minutes
>60 Minutes

Did the front desk check you in/out in a timely manner?

Yes
No

Did you have any problems scheduling a follow up appointment?

Yes
No

General Office Ratings

Excellent
Good
Fair
Poor
Courtesy and helpfulness of the receptionist when you called to make an appointment
Ability to get a timely appointment
Phone calls returned in a timely manner
Parking availability
Appearance of Reception/Waiting area
Appearance and cleanliness of staff
Amount of time the Provider spent with you
Explanation of treatment given
Interest and patience shown by Provider
General quality of care
Explanation of billing questions/statement

0
1 - 3
4 - 6
7 - 10
Number of times the Provider was interrupted during your appointment?

Yes
No
Would you refer other people to our practice?