2178 Mariner Blvd                                     Spring Hill, FL 34609                                    Tel (352)-556-4848                                    Fax (352)-556-4849 

Patient Survey
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Please take a few minutes to fill out this survey on the timeliness and quality of the service you received. Gulf Coast Medical Care welcomes your feedback and your answers will be kept completely confidential. Thank you for your participation.

Was the person who scheduled your appointment courteous and helpful?

In general, what is the quality of your health?

How would you rate our concern for your privacy?

How often have you visited Gulf Coast Medical Care within the past year?

Did you schedule an appointment by phone or did you drop in?

If you scheduled an appointment, did you have to wait longer than expected to get scheduled?

How easy was it to make an appointment by telephone?

How long did you wait to speak to a scheduling staff member?

If you were seeking a referral to a specialist, was your request handled in a timely manner?

How would you rate the courtesy of the staff at the reception desk?

How long did you wait in the reception area beyond your scheduled appointment time?

How long did you wait in the exam room before the physician appeared?

How would you rate the competence of the nurse who helped you?

How would characterize the concern that the nurse showed for your problem?

Did the nurse respond to your requests within a reasonable period?

Were you able to see the doctor of your choice?

Did you feel that your doctor spent an adequate amount of time with you?

Mark the boxes that characterize the demeanor of your doctor.

How would you rate the competence of your doctor?

Did you feel that your doctor’s examination was thorough?

Please rate the clarity of the doctor’s explanation of your condition and treatment options.

How well did your doctor include you in healthcare decisions?

Were your questions answered to your satisfaction?

Would you recommend this facility and its staff to your family and friends?

How would you rate the professionalism and competence of the person who took your blood and worked on your lab exam?


If you received a lab exam, was the service prompt, comfortable, and courteous?



Name (Optional):

Email (optional):

Contact Number (Optional):

Date Of visit (Optional):

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