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Survey Templates Health Care Surveys Medical Examination Services Survey Template

Medical Examination Services Survey Template

The Medical Examination Services Survey collects feedback on a patients' overall experience with their current medical services provider. Additionally, it collects data on what would they consider important in any medical examination services provider. The sample template has questions on the staff members involved, speed, efficiency, cleanliness, and comfort of the facility.

Use the survey results to improve your services and formulate a business strategy. This free survey template is ready to be used in your research. You can also customize it as per your needs.


The following set of questions are about with the medical examination services performed during routine examinations. Please rate the level of importance for each service.
Not At All Satisfied
Somewhat Satisfied
Neutral
Somewhat Satisfied
Very Satisfied
Not applicable/
Not sure
Speed in completing examinations
Accuracy and completeness in filling out report
Expertise of medical staff
Medical representative treatment
Services offered for examination
Delivery of reports to insurance office
Personal relationship
Not At All Satisfied
Somewhat Satisfied
Neutral
Somewhat Satisfied
Very Satisfied
Not applicable/
Not sure
Information received
Effort to make you feel comfortable
Friendliness of staff
Cleanliness
 
If a medical examination service were to guarantee:

(A)    Professionalism in the medical staff

(B)    Accurately filled out and completed reports

(C)    A completed report back to you within 3 days


Would you permanently change to this agency?
 
How would you rate on each of the following items with your current medical service provider?
Excellent
Very Good
Good
Fair
Poor
Not applicable/
Not sure
Speed in completing examinations
Accuracy and completeness in filling out report
Expertise of medical staff
Medical representative treatment
Services offered for examination
Delivery of reports to insurance office
Personal relationship
Excellent
Very Good
Good
Fair
Poor
Not applicable/
Not sure
Information received
Effort to make you feel comfortable
Friendliness of staff
Cleanliness