PATIENT INFORMATION
Patient E-mail
Your first visit here?
Your Age?
Your Sex?
A.ON THE PHONE
Very poor poor fair good very good
1. Ease of getting throughto the person or service you wanted
2. Friendliness of the person who answered your call
3. How easy was it to get an appointment for the tima and date you wanted
4. Availability of doctor to talk on the phone
5. How promptly were your calls returned?
Comments
B. IN THE WAITING AND RECEPTION AREA
Very poor poor fair good very good
1. Helpfulness of the person at the registration desk
2. Speed of the registration process
3. Privacy you felt during the registration and check-out
4. Comfort and pleasantness of the waiting area
5. How satisfactory was the process to obtain your insurance/billing information?
Comments
C. SEEING THE DOCTOR
Very poor poor fair good very good
1. Length of wait in the waiting area
2. Length of wait in the exam room before you were seen by the doctor
3. Courtesy of the doctor
4. Degree to which the doctor took your problem seriously
5. Doctor's concern for your comfort while treating you
6. Doctor's concern to explain your tests and treatment
7. Length of time the doctor spent with you
8. How informative was the doctor in dealing with your family?
9. Confidence in the doctor's skill and knowledge
Comments
D. NURSES
Very poor poor fair good very good
1. Courtesy of the nurse
2. Degree to which the nurse took your problem seriously
3. Nurse's concern for your comfort while treating you
4. Nurse's concern to explain your tests and treatment
5. Length of time the nurse spent with you
6. How informative was the nurse in dealing with your family?
7. Confidence in the nurse's skill and knowledge
Comments
E. X-RAY
Very poor poor fair good very good
1. Courtesy of the x-ray technician
2. Technician's concern for your comfort while treating you
3. Skill with which the x-ray was taken (quick, little pain,etc.)
Comments
F. BUSINESS OFFICE
Very poor poor fair good very good
1. How well was your bill handled and explained?
2. Staff concern for your privacy
Comments
G. FINAL RATINGS
Very poor poor fair good very good
1. Overall appearance and cleanliness
2. Degree to which the staff cared about you as a person
3. Convenience of office hours
4. Convenience of parking
5. Likelihood of recommending the doctor to others
Comments
   

 

Access your medical records
through our
Patient Portal!

Our Patient Portal allows
established patients to:
  • Request refills
  • Schedule appointments
  • Update your contact and insurance information
  • Check your medication list, medical history information and doctor's visits
  • Obtain your test results quickly
  • E-mail us securely

Please feel free to call our office directly:

586 Kearny Ave. , Kearny , NJ
201-997-7667
79 Hudson St., Suite 404 , Hoboken , NJ
201-659-7060
515 Madison Ave., Suite 1720 at 53rd, New York, NY
212-758-3939