407 Live Oak St Ste. 1, Beaufort, NC 28516 | info@seasidefamilypractice.com

(252) 728-2328

Seaside Family Practice Of Beaufort

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Patient Survey

Talk With Our Providers in Beaufort, NC

Patient Satisfaction Survey

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Which provider did you see today:

Sherry Kent, FNP

Carolina Griffin, FNP

Today's Date:

Day of Service:

Are you a New Patient or Established Patient:

New Patient

Established Patient

What is your Age:

What is your Gender:

What is your Race/Ethnicity:

Are you Hispanic/Latino:

Yes - I am Hispanic or Latino

No - I am NOT Hispanic or Latino

Do you consider this your regular primary source of care?

Yes

No

What is the highest grade level of school you have completed?

8th grade or less

Some high school, but did not graduate

OK

Some college or 2 year degree

4 year college graduate

Advanced graduate degree or more than 4 years of college

Did someone help you complete this survey

Yes

No

How did someone help you with completing this survey? (choose all that apply)

Read the questions to me

Selected the response that I gave

Answered the questions for me

Translated the questions into my language

Other

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How Would You Rate The Following:

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Ease of Getting Care

Ability to be Seen

Great

Good

OK

Fair

Poor

Office Hours

Great

Good

OK

Fair

Poor

Prompt Return Calls

Great

Good

OK

Fair

Poor

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Wait Times

Appointment Wait Time

Great

Good

OK

Fair

Poor

Lab Drawn Wait TIme

Great

Good

OK

Fair

Poor

Lab Draw Wait Time

Great

Good

OK

Fair

Poor

Test Result Wait Time

Great

Good

OK

Fair

Poor

Referral Wait Time

Great

Good

OK

Fair

Poor

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Your Provider/Clinician

Listens to You

Great

Good

OK

Fair

Poor

Takes Enough Time With You

Great

Good

OK

Fair

Poor

Explains What you Want to Know

Great

Good

OK

Fair

Poor

Gives You Good Advice and Treatment

Great

Good

OK

Fair

Poor

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Staff (Nurses, Medical Assistants, Office Staff, etc)

Friendly and Helpful

Great

Good

OK

Fair

Poor

Answers Your Questions

Great

Good

Option 3

Fair

Poor

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Confidentiality

Keeping My Personal Information Private

Great

Good

OK

Fair

Poor

If Not Great, Please Explain:

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About You

How Would You Rate your Overall Health

Great

Good

OK

Fair

Poor

How Would you Rate your Overall MENTAL or EMOTIONAL health

Great

Good

OK

Fair

Poor

If not great, what can we do to help?

Additional Comments:

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LAST NAME

EMAIL

PHONE

MESSAGE

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Doctor Taking Notes — Beaufort, NC — Seaside Family Practice of Beaufort

CONTACT INFORMATION

Phone: (252) 728-2328

Email: info@seasidefamilypractice.com

Address: 407 Live Oak St Ste. 1, Beaufort, NC 28516

Hours Of Operation:

Mon, Wed, Thu, Fri: 8:00 am - 4:30 pm
Tuesday: 8:00 am - 6:30 pm
Sat - Sun: Closed

OUR LOCATION

CONTACT INFORMATION

Phone: (252) 728-2328

Email: info@seasidefamilypractice.com

Address: 407 Live Oak St Ste. 1, Beaufort, NC 28516

Hours Of Operation:

Mon, Wed, Thu, Fri: 8:00 am - 4:30 pm
Tuesday: 8:00 am - 6:30 pm
Sat - Sun: Closed

OUR LOCATION

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