TTMG patient survey
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1. Default Section
1
. How have you heard of us?
How have you heard of us?
Phone Book
Newspaper Ad
Internet Search
Refigerator Magnets
Radio Ad
Referred by
Other (please specify)
2
. Do you currently use the phone book to find our phone number?
Do you currently use the phone book to find our phone number?
Yes
No
3
. What information have you seen/utilized on our website? (choose all that apply)
What information have you seen/utilized on our website? (choose all that apply)
Office hours/locations/maps
List of services we provide
Insurance information
Doctor profiles
Patient education links
Billing Information
News items
Forms for patients
4
. Is there any other information you’d like to see on our website?
Is there any other information you’d like to see on our website?
5
. How would you rate the availability of appointments?
How would you rate the availability of appointments?
Never able to get an appointment when I need it
Usually able
Always able to get an appointment when I need it
6
. If offered, would you use the internet to schedule your appointments?
If offered, would you use the internet to schedule your appointments?
yes
no
7
. If offered, would you use a secure email to correspond with your doctor regarding your care? (There would be a fee for this service)
If offered, would you use a secure email to correspond with your doctor regarding your care? (There would be a fee for this service)
Yes
No
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