Doctor Performance Review Survey
Help us evaluate and improve the quality of care by providing your feedback on doctor performance.
Your role
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Please Select
Patient
Family Member
Colleague
Nurse
Other
Department or Clinic
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Please Select
Internal Medicine
Pediatrics
Surgery
Obstetrics & Gynecology
Emergency
Other
Doctor's Name
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How would you rate the doctor's professionalism?
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1
2
3
4
5
How would you rate the doctor's communication skills?
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1
2
3
4
5
How would you rate the doctor's medical knowledge and expertise?
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1
2
3
4
5
How would you rate the doctor's bedside manner?
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1
2
3
4
5
Please indicate your level of agreement with the following statements about the doctor.
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Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The doctor listens carefully to concerns.
1
2
3
4
5
The doctor explains conditions and treatments clearly.
6
7
8
9
10
The doctor shows respect and empathy.
11
12
13
14
15
The doctor involves me in decision-making.
16
17
18
19
20
Overall, how satisfied are you with your experience with this doctor?
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Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
What did the doctor do well?
Suggestions for improvement
Submit Review
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