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Physician Performance Evaluation Form

A physician performance evaluation form may be used to evaluate the performance of a physician or any other medical professional. The form may include sections for each area of a physician's job performance and a separate section for overall performance. The form may be used by a hospital, medical group, or by insurance company.

Time to complete

2 minutes

Eligibility

This form is to be completed by a patient who was under the observation of the physician.

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Questions for Physician Performance Evaluation Form

1.

What is your name?

The answer should be a text input.

2.

Phone Number

The answer should be a phone number.

3.

Age

The answer should be a single choice:

Under 18
18-24 years old
25-34 years old
35-44 years old
45-54 years old
Over 55

4.

Name of Physician

The answer should be a text input.

5.

How often is the physician available when you need him/her?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

6.

How often does the physician explain things clearly?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

7.

How often does the physician show concern for your welfare?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

8.

How often does the physician seem interested in your problems?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

9.

How often does the physician seem up-to-date in his/her knowledge?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

10.

How often does the physician provide you with referrals to specialists when necessary?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

11.

How often are you able to get an appointment with the physician when you need one?

The answer should be a single choice:

Very often
Often
Sometimes
Rarely
Very rarely

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Here are some FAQs and additional information
on Physician Performance Evaluation Form

How often should a physician performance evaluation form be completed?

It is generally recommended that a physician performance evaluation form be completed at least once per year. However, the frequency with which the form is completed may vary depending on the needs of the organization or practice.

Who should complete a physician performance evaluation form?

A physician performance evaluation form should be completed by an individual or group who is familiar with the physician’s work. This may include supervisors, colleagues, or patients.

What information should be included in a physician performance evaluation form?

A physician performance evaluation form should include a variety of information about the physician’s performance. This may include clinical skills, bedside manner, communication abilities, and more.

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