Patient Satisfaction Survey

Was this your first visit to our office?
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If this was your first visit how did you hear about us?

What was the purpose of your visit?

Ease of setting your appointment
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Greeting by our receptionist when you arrived
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Cleanliness/ neatness of the waiting room
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Cleanliness/neatness of the procedure suite
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Length of time you had to wait before you called for your appointment
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Friendliness of our office staff
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Friendliness of the physician
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Ability of physician to put you at ease
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Quality of the service performed
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Degree to which your concerns were addressed by either the technician or the physician
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The ease of checking out and paying after the appointment
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How likely is it that you would recommend our office to your family members, co-workers, and friends?
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In your own words, let us know any positive experiences you had or issues or concerns you may have about our services o practices and procedures

Would you like to provide us with your contact information?