Patient Survey

We value your opinion!

We are continually striving to provide you with the BEST patient care. Please share with us if you were happy with your visit or if there is a way, you feel, we can serve you better by answering the following questions regarding our service:

Name (Optional)

Please tell us how satisfied or dissatisfied you were with each of the following:

1) How satisfied were you with the way you were treated by the staff at our office?

2) How satisfied were you with the way you were treated by the nurse?

3) How satisfied were you with the way you were treated by the doctor?

4) How satisfied were you with the way your questions were answered?

5) How would you rate the courtesy you were shown by staff at our office?

Please tell us how much you agree or disagree with the following statements:

6) The staff was knowledgeable.

7) The staff was friendly and courteous.

8) The nurse was knowledgeable.

9) The nurse was friendly and courteous.

10) The doctor was friendly and courteous.

11) My questions were answered fully.

12) My visit to the office/clinic was a pleasant experience.

13) Overall, how would you rate your visit to our office?

14) What, if any, additional comments do you have? (Optional)

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