Survey

Please take a moment and let us know how we are doing by completing the survey below. We thank you for your time and your feedback.

Who do you see in our clinic?*

Who referred you to our office?*

Visit type*

How long did you have to wait prior to seeing your physician?*
Less than 10 minutes
11 to 20 minutes
21 to 30 minutes
31 minutes to 1 hour
Longer than 1 hour (Please explain wait time in comments)
Was the front desk staff friendly?*
Yes
No
Was the nursing staff friendly?*
Yes
No
Did the physician address all of your concerns during the appointment?*
Yes
No
Was the checkout / billing staff friendly?*
Yes
No
Was every effort made to make your next appointment time as convenient as possible?*
Yes
No
No return appointment was scheduled
Overall how would you rate our office?*
1 (Unsatisfactory)
2 (Poor)
3 (Average)
4 (Above average)
5 (Excellent)
Would you recommend our office to a friend?*
Yes
No
Please feel free to expand on any of the questions listed above, or tell us about other areas of our office that we can improve.

If you would not recommend us to a friend please explain why.

Submit
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