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EZ-Net Promise Care

Patient Satisfaction Survey

Nivano Physicians is conducting this survey to identify how you feel about the services we provide to our members. The results of this survey will be used to improve our quality of care and services. Please be assured that any opinions you express will be kept confidential. Please feel free to complete the below survey. Thank you for your assistance!

Patient Satisfaction Survey

Name of your Primary Care Physician (PCP):

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Please circle or indicate the answer that best applies:

1 a. When you scheduled your appointment how long were you told the wait would be to get in to see your physician?

Same day

Next day

2-10 Days

2-4 weeks

2 months or more

b.Were you satisfied or unsatisfied waiting?

Satisfied

Unsatisfied

2 a. On the day of your visit, how long did you have to wait in the office until your PCP saw you?

Minutes

Hours

b. Were you satisfied or unsatisfied with the total waiting time?

Satisfied

Unsatisfied

N/A

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How would you rate the following?

3. The appearance of the waiting room:

Below average

Average

Above average

4. The appearance of the exam room:

Below average

Average

Above average

5. How courteous the front office staff was:

Below average

Average

Above average

6. How courteous the nursing staff was:

Below average

Average

Above average

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How would you rate your physician in the following areas?

7. How well your PCP listened to you during your visit.

Poor

Fair

Good

Very good

8. Thoroughness of the examination:

Poor

Fair

Good

Very good

9. How well your PCP explained your condition:

Poor

Fair

Good

Very good

10. How well your PCP explained your treatment plan:

Poor

Fair

Good

Very good

11. The amount of time your PCP spent with you:

Poor

Fair

Good

Very good

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On a scale from 1 to 10, 10 being the best, please rate the following:

12. Overall, how would you rate your last visit to your PCP?

13. Overall, how would you rate your PCP?

14. Could you tell us the briefly the main reasons behind your answers to the previous two questions?

15. a. Was your last visit to your PCP approximately the same in terms of staff interaction, PCP interaction etc., as other visits you have had to that office?

Yes

No

N/A (one visit only)

b. If “NO”, what was different? (For example: Improved, worse, staff change?)

16. Have you had any billing or payment problems?

YES

NO

17. Would you recommend your PCP to a friend or co-worker?

Yes

No

Uncertain

18. Are you considering changing physicians?

YES

NO

N/A

19. How would you rate your access to medical care when you need it?

Poor

Fair

Good

Excellent

20. Have you ever had a referral from your PCP to see a Specialist?

YES

NO

N/A

21. Do you feel you have reasonable access to a Specialist (s)?

YES

NO

N/A

22. Once you received a referral from your PCP, do you feel you were seen by the Specialist in a reasonable amount of time?

YES

NO

N/A

23. How long did you have to wait to get in to see the Specialist? (last one if more than one in the past)

Same day

Next day

1 week

2-4 weeks

3 months or more

24. Were you satisfied or unsatisfied with this waiting time to be seen by the Specialist?

Satisfied

Unsatisfied

N/A

25. In the last 6 months, how often were the UM Coordinator, Nurse Case Manager, and Customer Service Representatives at the Nivano Physicians as helpful as you thought they should be?

Never

Somehow

Always

26. Do you know about the Language Assistance Program (LAP), for face-to-face interpreter service and translation of written materials?

Yes

No

Comments: You may include your name and address here if you wish, as well as any additional comments.

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Contact info

916.407.2000

customerservice@nivanophysicians.com

Sacramento Office:

1420 River Park Drive, Suite 100

Sacramento, CA 95815

Mailing Address:

PO Box 869140, Plano, TX 75086

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