Survey

We are interested in receiving your feedback about the care provided at our Practice. Please take a few minutes to complete this survey and return it to us. Your responses are important to us.

Satisfaction of the following:

Ease of making appointments for checkups (physical exams, well visits, routine follow-up appointments)? Ease of making appointments for sickness? Ease in communication with your Doctor by telephone when you call during office hours? The time it takes someone from our office to respond when you call or email with an urgent problem? Waiting time in our office?

Ease in obtaining follow-up information and care (test results, medicines, care instructions) Overall medical care at your Doctor’s office?
Our office’s appearance?
Our office’s convenience (location, parking, hours, office layout)? The way we teach you about improving your health?

Please tell us how caring your Doctor and our staff are:

How caring is your Doctor? How caring are our nursing staff?

How caring are our office staff?

Please tell us:

Fullname * Email * Phone Number * How many times have you visited this Doctor’s office in the past 12 months for medical care?

Your age in years How long have you been a patient at this practice? Your gender

Comments on how we could improve our service:

Comments

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Survey

Satisfaction of the following:

Please tell us how caring your Doctor and our staff are:

Please tell us:

Comments on how we could improve our service:

Survey submitted

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