Find out what patients think about everything from parking to quality of care.

"If you have a bad experience in a restaurant, you rarely complain. You just don't return—and you don't recommend the place to your friends," says Keith C. Borglum, a consultant with Professional Management and Marketing in Santa Rosa, CA. "Similarly, patients who are unhappy with the way your office is run aren't likely to tell you, but they're probably on the lookout for another physician." The form below, from Medical Practice Forms: Every Form You Need to Succeed, by Borglum and Diane M. Cate, lets patients air their grievances anonymously, and helps you identify trouble spots.

To get a representative sample, Borglum recommends giving the form to the first 100 patients you see after a predetermined date, without regard for insurance coverage, age, and other demographics. Hand patients the form and a stamped envelope—addressed, preferably, to your home or a post office box—at the end of the visit, and ask them to complete it and mail it.

Review the responses yourself or with your office manager. If several respondents indicate that something is wrong, fix it, then send a letter to all patients announcing the new policy. For example: "We would like to thank those of you who completed the report card on our office. In response to your input, we now have weekend office hours."

Edit the form to reflect distinctive services that your practice offers, such as patient education programs or computers in the waiting room.

—Senior Editor
Gail Garfinkel Weiss

This form is available in:   To view the form in PDF, you must have Adobe Acrobat Reader installed on your system. If you do not have this free program, click on the icon below to link to the Adobe download page. To view the form in Word you must have Word 2000 or better. If you don't have this program you can download the free Microsoft Word 97/2000 Viewer. (You cannot edit an open document in Word Viewer. However, you can copy text to the Clipboard to paste it in other applications). Other forms and patient handouts are available in the Clip and Copy section of our Web site at www.memag.com .

Gail Weiss. Clip and Copy: Getting patients to grade your office. Medical Economics Oct. 24, 2003;80:62.