Primary Care Patient Satisfaction SurveyPatient Satisfaction Survey, NLH Provider ClinicsThank you!Contact InformationPlease enter your first and last name.(Required) First Last Please enter your date of birth.(Required) MM slash DD slash YYYY Please enter your age (years).(Required)Phone(Required)Who is your Primary Insurance Provider (PIP) or insurance carrier?(Required)Please enter the name of the provider (doctor) during your last appointment.(Required)Where was this practice located?(Required)When was your last appointment?(Required) MM slash DD slash YYYY We wish to ensure that your experience as a patient at Nathan Littauer Primary/Specialty Care was satisfactory. Please answer honestly.1. Appointment available within a reasonable amount of time Excellent Very Good Good Fair Poor2. The days and times you are offered for appointments are Excellent Very Good Good Fair Poor3. The personal manner of the provider or staff that you saw today Excellent Very Good Good Fair Poor4. My provider clearly explained any follow up needed from today’s visit, including: any communication with specialists, labs or imaging ordered, changes in medication, and/or next appointment Excellent Very Good Good Fair PoorIs there any way we can improve our services to you, or if you would like to describe your experience today, please tell us about it:Δ
