Survey

HOW SATISFIED ARE YOU WITH:
YOUR APPOINTMENT:
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Waiting time in the reception area
Waiting time in the exam room
OUR STAFF:
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The friendliness and courtesy of our receptionists
The caring concern of our nurses
The helpfulness of the people in our business office
The professionalism of our technical staff
YOUR VISIT WITH THE HEALTHCARE PROVIDER
Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
The healthcare provider listening to you
The healthcare provider taking time to answer your questions
The healthcare provider adequately explaining treatment options
           
YOUR VISIT TO OUR CLINIC
YES
NO
Would you use us again in the future?
Would you recommend us to friends and family?
COMMENTS: