Patient Survey

Please take a moment and fill in the questions. if you don't know the answer just skip the question.

1. Which physician did you see?
 Dr. Hibbert Curt Niederhauser PA-C Nurse Visit

2. Was our clinic able to get you scheduled within a reasonable amount of time?
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3. At the time of your appointment was the physician able to see you within a reasonable amount of time?
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4. Was our staff pleasant?
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5. Was our staff professional?
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6. Was the Physician you saw Pleasant?
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7. Was the Physician you saw professional?
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8. Did the physician you saw answer your questions in a manner that you could understand?
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9. Was the waiting and Exam room clean and pleasant?
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10. Did the Physician spend enough time with you?
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11. Was our staff helpful?
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12. Was our staff professional on the telephone?
 Poor Fair Good Very Good Excellent N/A

13. Overall, How satisfied were you with our office?
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14. Would you Recommend Tooele Urology to family and Friends?
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15. Were you given easy to understand instructions on your plan of care?
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1. Do you have any suggestions for our office where we can make improvements?

2. Was there anything that happened during your visit that was unsatisfactory, that we could work on for next time?

3. Was there anything that happened during your visit that went exceptionally well that you would like to share?

4. Do you have any other further concerns or comments you would like to share with us?

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