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Physician Performance Evaluation Template
1.
How quickly does your doctor's staff help you when you need help?
Extremely quickly
Very quickly
Moderately quickly
Slightly quickly
Not at all quickly
2.
How friendly is your doctor's office staff?
Extremely friendly
Very friendly
Moderately friendly
Slightly friendly
Not at all friendly
3.
How knowledgeable is your doctor's office staff?
Extremely knowledgeable
Very knowledgeable
Moderately knowledgeable
Slightly knowledgeable
Not at all knowledgeable
4.
How easy is it to schedule urgent appointments with your doctor when you're ill?
Extremely easy
Very easy
Moderately easy
Slightly easy
Not at all easy
5.
How easy is it to get to your doctor's office?
Extremely easy
Very easy
Moderately easy
Slightly easy
Not at all easy
6.
During a typical office visit, does your doctor spend too much time with you, too little time with you, or about the right amount of time with you?
Much too much
Somewhat too much
Slightly too much
About the right amount
Slightly too little
Somewhat too little
Much too little
7.
How much do you trust your doctor to make medical decisions that are in your best interests?
A great deal
A lot
A moderate amount
A little
Not at all
8.
How helpful is your doctor at explaining your medical condition(s)?
Extremely helpful
Very helpful
Moderately helpful
Slightly helpful
Not at all helpful
9.
How well does your doctor explain how to take your medicine(s)?
Extremely well
Very well
Moderately well
Slightly well
Not at all well
10.
How well does your doctor answer your questions?
Extremely well
Very well
Moderately well
Slightly well
Not at all well
11.
How well does your doctor listen to you?
Extremely well
Very well
Moderately well
Slightly well
Not at all well
12.
Overall, are you satisfied with your doctor, dissatisfied with your doctor, or neither satisfied nor dissatisfied?
Extremely satisfied
Quite satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Quite dissatisfied
Extremely dissatisfied
13.
How likely are you to recommend your doctor to family or friends?
Extremely likely
Very likely
Moderately likely
Slightly likely
Not at all likely
Current Progress,
0 of 13 answered