We thank you in advance for completing this questionnaire for Orlando Heart Center. All information will be kept strictly confidential and will be used for the sole purpose of improving the medical practice.

Instructions

• Please rate the services you received from our practice.

• Choose the statement that best describes your experience.

• If a question does not apply to you, please choose "N/A".

1. What is the name of your doctor?

Melvin J. Johnson, III, M.D. Scott D. Greenwood, M.D. Irwin R. Weinstein, M.D. George E. Andreae, M.D. Enrique Chapman, M.D. Ronald R. Domescek, M.D. Aurelio Duran, M.D. Luis G. Alvarez, M.D. Israel J. Mantecon, M.D. Jose A. LeFran, M.D. Roland A. Filart, M.D. Robert P. Dalton, M.D. Pavel A. Guguchev, M.D. Sanjeev K. Shroff, M.D. Mark A. Steiner, M.D. James H. Tarver, M.D. Parimal B. Maniar, M.D. Linda E. Jaffe, M.D. Deepak P. Vivek, M.D. Joel R. Garcia, M.D. Linus A. Wodi, M.D. Adam J. Waldman, M.D. Paul R. Sander, M.D.

2. Ease of scheduling your appointment?

Very Good Good Fair Poor Very Poor N/A

3. Courtesy of person who scheduled your appointment?

Very Good Good Fair Poor Very Poor N/A

4. Our helpfulness on the telephone?

Very Good Good Fair Poor Very Poor N/A

5. Our promptness in returning your phone calls?

Very Good Good Fair Poor Very Poor N/A

6. Speed of the registration process?

Very Good Good Fair Poor Very Poor N/A

7. Courtesy of staff in the registration area?

Very Good Good Fair Poor Very Poor N/A

8. Comfort and pleasantness of the waiting area?

Very Good Good Fair Poor Very Poor N/A

9. Length of wait before going to exam room?

Very Good Good Fair Poor Very Poor N/A

10. Comfort and pleasantness of the exam room?

Very Good Good Fair Poor Very Poor N/A

11. Friendliness/ courtesy of the nurse/assistant?

Very Good Good Fair Poor Very Poor N/A

12. Concern the nurse/ assistant showed for your problem?

Very Good Good Fair Poor Very Poor N/A

13. Waiting time in exam room before being seen by the care provider?

Very Good Good Fair Poor Very Poor N/A

14. During your visit, your care was provided primarily by a...

Doctor Physician Assistant (P.A.) Nurse Practitioner (NP) I Don't Know

15. Friendliness/ courtesy of the care provider

Very Good Good Fair Poor Very Poor N/A

16. Explanations the care provider gave you about problem or condition

Very Good Good Fair Poor Very Poor N/A

17. Concern the care provider showed for your question or worries

Very Good Good Fair Poor Very Poor N/A

18. Care provider's efforts to include you in decisions about your treatment

Very Good Good Fair Poor Very Poor N/A

19. Information the care provider gave you about medications

Very Good Good Fair Poor Very Poor N/A

20. Instructions the care 'provider gave you about follow-up care

Very Good Good Fair Poor Very Poor N/A

21. Degree to which care provider talked with you using words you could understand

Very Good Good Fair Poor Very Poor N/A

22. Amount of time the care provider spent with you

Very Good Good Fair Poor Very Poor N/A

23. Your confidence in this care provider

Very Good Good Fair Poor Very Poor N/A

24. Likelihood of your recommending this care provider to others

Very Good Good Fair Poor Very Poor N/A

25. Convenience of our office hours

Very Good Good Fair Poor Very Poor N/A

26. Our sensitivity to your needs

Very Good Good Fair Poor Very Poor N/A

27. Our concern for your privacy

Very Good Good Fair Poor Very Poor N/A

28. Overall cheerfulness of our practice

Very Good Good Fair Poor Very Poor N/A

29. Overall cleanliness of our practice

Very Good Good Fair Poor Very Poor N/A

30. Overall rating of care received during your visit

Very Good Good Fair Poor Very Poor N/A

31. Likelihood of your recommending our practice to others

Very Good Good Fair Poor Very Poor N/A

32. Comments (describe your good or bad experience)

33. Patient's Name: (optional)

34. Telephone Number:(optional)

At Orlando Heart Center we understand privacy is very important to our patients.
Please feel free to review our privacy policy at any time.