Exit this survey
1
. When you telephoned our office, was your call handled courteously?
When you telephoned our office, was your call handled courteously?
Yes
No
N/A
Comment
2
. Which best describes the handling of your call?
Which best describes the handling of your call?
Excellent
Good
Average
Poor
N/A
Comment
3
. Did you receive an appointment within a reasonable length of time?
Did you receive an appointment within a reasonable length of time?
Yes
No
N/A
Comment
4
. Have you ever telephoned our office and received no response?
Have you ever telephoned our office and received no response?
Yes
No
Comment
5
. Upon arrival, did the receptionist greet you courtesly?
Upon arrival, did the receptionist greet you courtesly?
Yes
No
Comment
6
. Were our technicians courteous, helpful, and efficient?
Were our technicians courteous, helpful, and efficient?
Yes
No
Comment
7
. Was our staff neat in appearance and dress?
Was our staff neat in appearance and dress?
Yes
No
Comment
8
. From your appointment time, how long did you wait before being seen?
From your appointment time, how long did you wait before being seen?
9
. If you were made to wait long, was there a reason given for the delay?
If you were made to wait long, was there a reason given for the delay?
Yes
No
N/A
Comment
10
. How would you rate the doctor on patience, warmth, and interest in your problem?
How would you rate the doctor on patience, warmth, and interest in your problem?
Excellent
Good
Average
Poor
Comment
11
. How would you rate the doctor on professional thoroughness in the examination?
How would you rate the doctor on professional thoroughness in the examination?
Excellent
Good
Average
Poor
Comment
12
. Did you understand the doctor's explanation of the results of your office visit?
Did you understand the doctor's explanation of the results of your office visit?
Yes
No
Comment
13
. Did you have difficulty understanding the educational materials provided?
Did you have difficulty understanding the educational materials provided?
Yes
No
N/A
Comment
14
. Were you satisfied with the level of care and attention you received?
Were you satisfied with the level of care and attention you received?
Yes
No
Comment
15
. Which doctor provided your care?
Which doctor provided your care?
Dr. Costa
Dr. German
Dr. Koop
Dr. Luketic
Dr. Raffoul
Dr. C. Tam
Dr. R. Tam
16
. In which location did you receive care?
In which location did you receive care?
Toledo - Regency Ct.
Oregon
Perrysburg
Bowling Green
17
. Any additional comments or suggestions:
Any additional comments or suggestions:
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