Cosmetic 3Q 2010
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1.

1. When you called for your appointment, were you satisfied with the response from the person who answered the telephone?

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
1	*When you called for your appointment, were you satisfied with the response from the person who answered the telephone? 1 Fell short of my expectations	1 Partially met my expectations	1 Met my expectations	1 Exceeded my expectations	1 N/A

2. When you arrived at the office, did you find the receptionist to be:

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
Friendly and Courteous?	*When you arrived at the office, did you find the receptionist to be: Friendly and Courteous? Fell short of my expectations	Friendly and Courteous? Partially met my expectations	Friendly and Courteous? Met my expectations	Friendly and Courteous? Exceeded my expectations	Friendly and Courteous? N/A
Helpful and Attentive?	Helpful and Attentive? Fell short of my expectations	Helpful and Attentive? Partially met my expectations	Helpful and Attentive? Met my expectations	Helpful and Attentive? Exceeded my expectations	Helpful and Attentive? N/A

3. How acceptable was the amount of time spent in the reception area and exam room, before seeing the provider?

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
3	*How acceptable was the amount of time spent in the reception area and exam room, before seeing the provider? 3 Fell short of my expectations	3 Partially met my expectations	3 Met my expectations	3 Exceeded my expectations	3 N/A

4. When you were called to the exam room, did you find our medical assistant to be:

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceded my expectations	N/A
Friendly and Courteous?	*When you were called to the exam room, did you find our medical assistant to be: Friendly and Courteous? Fell short of my expectations	Friendly and Courteous? Partially met my expectations	Friendly and Courteous? Met my expectations	Friendly and Courteous? Exceded my expectations	Friendly and Courteous? N/A
Competent and Professional?	Competent and Professional? Fell short of my expectations	Competent and Professional? Partially met my expectations	Competent and Professional? Met my expectations	Competent and Professional? Exceded my expectations	Competent and Professional? N/A
Empathetic and Caring?	Empathetic and Caring? Fell short of my expectations	Empathetic and Caring? Partially met my expectations	Empathetic and Caring? Met my expectations	Empathetic and Caring? Exceded my expectations	Empathetic and Caring? N/A

5. During your time with the provider did you find her to be:

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
Friendly and Courteous?	*During your time with the provider did you find her to be: Friendly and Courteous? Fell short of my expectations	Friendly and Courteous? Partially met my expectations	Friendly and Courteous? Met my expectations	Friendly and Courteous? Exceeded my expectations	Friendly and Courteous? N/A
Competent and Professional?	Competent and Professional? Fell short of my expectations	Competent and Professional? Partially met my expectations	Competent and Professional? Met my expectations	Competent and Professional? Exceeded my expectations	Competent and Professional? N/A
Empathetic and Caring?	Empathetic and Caring? Fell short of my expectations	Empathetic and Caring? Partially met my expectations	Empathetic and Caring? Met my expectations	Empathetic and Caring? Exceeded my expectations	Empathetic and Caring? N/A

6. Did the provider spend an appropriate amount of time with you, answer your questions and explain treatment options to your satisfaction?

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
6	*Did the provider spend an appropriate amount of time with you, answer your questions and explain treatment options to your satisfaction? 6 Fell short of my expectations	6 Partially met my expectations	6 Met my expectations	6 Exceeded my expectations	6 N/A

7. If you saw a Patient Care Coordinator during your visit, did you find her to be:

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
Friendly and Courteous?	*If you saw a Patient Care Coordinator during your visit, did you find her to be: Friendly and Courteous? Fell short of my expectations	Friendly and Courteous? Partially met my expectations	Friendly and Courteous? Met my expectations	Friendly and Courteous? Exceeded my expectations	Friendly and Courteous? N/A
Competent and Professional?	Competent and Professional? Fell short of my expectations	Competent and Professional? Partially met my expectations	Competent and Professional? Met my expectations	Competent and Professional? Exceeded my expectations	Competent and Professional? N/A
Sympathetic and Caring?	Sympathetic and Caring? Fell short of my expectations	Sympathetic and Caring? Partially met my expectations	Sympathetic and Caring? Met my expectations	Sympathetic and Caring? Exceeded my expectations	Sympathetic and Caring? N/A

8. If a procedure was recommended, did the PCC discuss with you information regarding the recommended procedure(s) to your satisfaction?

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
8	*If a procedure was recommended, did the PCC discuss with you information regarding the recommended procedure(s) to your satisfaction? 8 Fell short of my expectations	8 Partially met my expectations	8 Met my expectations	8 Exceeded my expectations	8 N/A

9. If you had a procedure were you satisfied with the results?

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
9	*If you had a procedure were you satisfied with the results? 9 Fell short of my expectations	9 Partially met my expectations	9 Met my expectations	9 Exceeded my expectations	9 N/A

10. When you checked out, did you find the person to be:

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
Friendly and Courteous?	*When you checked out, did you find the person to be: Friendly and Courteous? Fell short of my expectations	Friendly and Courteous? Partially met my expectations	Friendly and Courteous? Met my expectations	Friendly and Courteous? Exceeded my expectations	Friendly and Courteous? N/A
Helpful and Attentive?	Helpful and Attentive? Fell short of my expectations	Helpful and Attentive? Partially met my expectations	Helpful and Attentive? Met my expectations	Helpful and Attentive? Exceeded my expectations	Helpful and Attentive? N/A

11. Rate your overall experience with the practice

	Fell short of my expectations	Partially met my expectations	Met my expectations	Exceeded my expectations	N/A
11	*Rate your overall experience with the practice 11 Fell short of my expectations	11 Partially met my expectations	11 Met my expectations	11 Exceeded my expectations	11 N/A

12. Would you recommend our practice to your friends/family?

	No	Yes
12	*Would you recommend our practice to your friends/family? 12 No	12 Yes

13. WE APPRECIATE RECEIVING ALL TYPES OF COMMENTS AS WE STRIVE TO GET BETTER EVERY DAY. PLEASE LET US KNOW ABOUT YOUR VISIT. IF YOU WOULD LIKE FOR US TO FOLLOW UP WITH YOU PLEASE SUBMIT YOUR NAME AND NUMBER AS THESE SURVEYS ARE ANONYMOUS

WE APPRECIATE RECEIVING ALL TYPES OF COMMENTS AS WE STRIVE TO GET BETTER EVERY DAY. PLEASE LET US KNOW ABOUT YOUR VISIT. IF YOU WOULD LIKE FOR US TO FOLLOW UP WITH YOU PLEASE SUBMIT YOUR NAME AND NUMBER AS THESE SURVEYS ARE ANONYMOUS

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