PIIM - Internal Medicine primary care physician practice...Billing Information...Patient Survey

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We appreciate your feedback. Below are questions about your recent office visit. Please check the box next to the question that best indicates your opinion. If the question does not apply to your situation, please mark “Not Applicable”. This survey is designed to help us improve the services we provide for you. Thank You for taking the time to complete this survey.

Are you a New Patient to our practice?:	Yes	No
Which office was your appointment in?:	Ann Arbor	Canton
Which office do you normally visit?:	Ann Arbor	Canton
What was the date of your appointment?:
What time of day was your appointment?:	Morning	Afternoon

Prior To Your Appointment

Ease of getting through to the physician’s office by telephone?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Courtesy of Telephone Service Specialist taking your call?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Availability of a nurse to speak with on the telephone during office hours?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

At The Time of Your Appointment

Courtesy of Welcoming Service Specialist?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The registration process (simplicity, speed, etc)?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The comfort of the waiting room?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The wait time to see the physician?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The amount of time spent with the physician?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The physician’s personal manner (courtesy, respect, sensitivity)?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The nurse’s personal manner?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Respect shown for your privacy?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Courtesy of Discharge Service Specialist?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Ease of arranging a follow-up visit?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Ease of having the Discharge Service Specialist arrange appointments to outside facilities?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Other Services Offered At Our Practice

Ease of getting your billing inquiries answered by telephone?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The courtesy of Billing Service Specialists?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The access to Managed Care Representatives by telephone for referrals or other information?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The courtesy of the Managed Care Representative?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

Ease of requesting a referral online?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The usefulness of the practice web site?

N/A			Poor	Fair	Good	Very Good	Excellent
0			1	2	3	4	5

The likelihood that you would recommend this practice to someone you know?