NYC Docs
Help Desk : (917) 634-9600
1888 Westchester Ave, Suite B, The Bronx, NY 10472 Bronx Office


Take Control with Confidence and Security

Patient Feedback Survey

Patient Feedback Survey is a useful method for gathering patient experiences, thoughts, and insights regarding the healthcare services they have received. Patients can use this form to provide their feedback on a variety of areas, including effectiveness of treatment, wait times, clinic cleanliness, staff professionalism, communication with healthcare professionals, facility environment and overall satisfaction. NYCDocs can better meet the requirements and expectations of their clients by gathering patient feedback, which also helps them discover areas for improvement and increase patient satisfaction levels. Therefore they can focus on providing continuous quality improvement and enhancing patient-centered care.


Fill all information below

1. Are you/family/caregiver able to see your doctor when you need to? *

2. Can you/family/caregiver be seen on the same day if you call for an appointment? *

3. Do you/family/caregiver know that there is a phone number that you can call to receive medical advice from the doctor after regular business hours? *

4. When you/family/caregiver call your doctor with a medical question, do you get an answer on that same day? *

5. The practice space is clean and inviting? *


Fill all information below

6. Does your doctor explain things in a way that is easy to understand? *

7. Does your doctor talk with you about the medications you are taking at each visit? *

8. Are medical staff friendly and helpful? *


Fill all information below

9. When blood tests, x-rays, or other tests are ordered, does the practice give you the results? *

10. If you/family/caregiver have received care from a specialist, does your doctor seem to know about the care you received? *

Self-Management Support

Fill all information below

11. Does your doctor provide information on ways to improve your health? *

12. Has your doctor asked if there are things that make it hard for you to take care of your health? *

13. Have staff at the practice recommended services in your community or offered their own workshops to help improve your health (i.e., weight management groups, nutrition/meal support)? *

14. Are recommendations to you/family/caregiver received (including community service and supports) to improve your health helpful? *


Fill all information below

15. What is your preferred method of communication? *

16. How do you consider the waiting time? *

17. Do you prefer appointments during the morning, afternoon, evening, or weekends? *

18. Which weeknight would you prefer extended hours? *

Patient Feedback

How would you rate your overall experience?