Patient Satisfaction Survey

Your responses will help us provide the best service possible.

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1. Convenience of our office hours
Excellent Very Good Good Poor n/a
2. Ease of making your appointment
Excellent Very Good Good Poor n/a
3. Promptness with which you were seen by the doctor
Excellent Very Good Good Poor n/a
4. Thoroughness of care you received
Excellent Very Good Good Poor n/a
5. Clarity of Doctor's explanations
Excellent Very Good Good Poor n/a
6. Doctor's friendliness and courtesy
Excellent Very Good Good Poor n/a
7. Staff's friendliness and courtesy
Excellent Very Good Good Poor n/a
8. Help with understanding your insurance coverage
Excellent Very Good Good Poor n/a
9. Comfort and cleanliness of office
Excellent Very Good Good Poor n/a
10. Overall satisfaction with your visit
Excellent Very Good Good Poor n/a
11. Will you be returning to see us?
Yes No Uncertain
12. Would you recommend us to others?
Yes No Uncertain
How can we improve? Please enter any comments or suggestions here:
Your Name (optional)
Your Email (optional)
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