Patient Experience Survey Please provide honest feedback based on your recent experiences at our pain clinic. Your input is valuable to us as we strive to provide the best possible care. Click 'Next' to start the survey. Pre-Appointment Experience Questions 1. How easy was it to schedule your appointment? (1 = Very Difficult. 10 = Very Easy) 1 2 3 4 5 6 7 8 9 10 2. How adequate was the information and instructions received prior to your appointment? (1 = Not at all. 10 = Extremely Adequate) 1 2 3 4 5 6 7 8 9 10 Clinic Environment & Staff Questions 3. How would you rate the cleanliness, maintenance, and comfort of our clinic? (1 = Very poor. 10 = Excellent) 1 2 3 4 5 6 7 8 9 10 4. How would you rate the friendliness and professionalism of our reception staff? (1 = Very poor. 10 = Excellent) 1 2 3 4 5 6 7 8 9 10 5. How attentive and supportive did you find the nurses and medical assistants? (1 = Very poor. 10 = Extremely attentive & supportive) 1 2 3 4 5 6 7 8 9 10 Consultation & Treatment Questions 6. How well did your doctor listen to your concerns and understand your pain history? (1 = Not at all. 10 = Extremely well) 1 2 3 4 5 6 7 8 9 10 7. How clearly were your treatment options explained to you? (1 = Not at all clear. 10 = Very clear) 1 2 3 4 5 6 7 8 9 10 8. How confident do you feel in the treatment plan created for you? (1 = Not at all. 10 = Extremely) 1 2 3 4 5 6 7 8 9 10 Pain Management Outcomes 9. How much has your pain level improved since starting treatment at our clinic? (1 = Worsened. 10 = Significantly improved) 1 2 3 4 5 6 7 8 9 10 Overall Experience Questions 10. How likely are you to recommend our pain clinic to others? (1 = Very unlikely. 10 = Very likely) 1 2 3 4 5 6 7 8 9 10 11. How likely are you to continue your care at our clinic? (1 = Very unlikely. 10 = Very likely) 1 2 3 4 5 6 7 8 9 10 Feedback Please provide specific comments on what you like most about our clinic: Please suggest any areas for improvement: Optional: Your Name Your Doctor Would you like someone from our team to follow up with you regarding your survey answers and feedback? Yes No If you selected yes, please leave your phone number or email: Thank you for your valuable feedback! Send