Patient Satisfaction Survey


Thank you for taking a few minutes to help us improve what we do!

For 1 through 5, read the statement and select one of the five responses by clicking a dot in the appropriate box. Then, please elaborate by typing into the text box labeled "Comments".

6, 7 and 8 just need an objective answer to the questions.

9 is optional.


1.

The "feel" of Dr. Victoria Martin's waiting room and private office (decor, ambiance, furniture, background music, etc.) is pleasant and comfortable.

Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree

Comments:

 

2.

The office staff is friendly, helpful and professional.

Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree

Comments:

 

3.

Dr. Martin is professional and knowledgeable in her field.

Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree

Comments:

 

4.

I am satisfied with my treatment so far.

Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree

Comments:

 

5.

My overall experience with Dr. Martin's office has met my expectations.

Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree

Comments:

 

6.

Please describe what you like most about Dr. Martin's office.

Comments:

 

7.

Please describe what you like least about Dr. Martin's office.

Comments:

 

8.

Online Suggestion Box:

If you were in-charge, what would you do or change to improve the office?

Comments:


The next two questions are completely optional.

If you wish to remain anonymous, just leave #9 blank

Finish by clicking on the "Save" button.


9.

Your Name: 

Email: 


Thanks again for your feedback!


Victoria Martin, M.D.
Child, Adolescent and Adult Psychiatry

For the Dallas, Ft. Worth Metroplex
and all of North Texas

(972) 994-0540
1219 Abrams Road, Suite 240
Richardson, Texas 75081

 

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