Patient Satisfaction Survey
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When you called our office your call was handled promptly and courteously.

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Strongly Agree	*When you called our office your call was handled promptly and courteously. Strongly Agree Pick one
Agree	Agree Pick one
Neutral	Neutral Pick one
Disagree	Disagree Pick one
Strongly Disagree	Strongly Disagree Pick one

Your appointments were made within a reasonable time frame.

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Strongly Agree	*Your appointments were made within a reasonable time frame. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

The receptionist was friendly and helpful.

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Strongly agree	*The receptionist was friendly and helpful. Strongly agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly disagree	Strongly disagree Pick One

The office was clean and comfortable.

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Strongly agree	*The office was clean and comfortable. Strongly agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly disagree	Strongly disagree Pick One

The staff was friendly and courteous.

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Strongly Agree	*The staff was friendly and courteous. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

You were allowed adequate time with the physician.

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Strongly Agree	*You were allowed adequate time with the physician. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

You felt comfortable making comments and asking questions of our physician.

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Strongly Agree	*You felt comfortable making comments and asking questions of our physician. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

Physician explanation of diagnosis, treatment, and medicine was presented in an understandable manner.

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Strongly Agree	*Physician explanation of diagnosis, treatment, and medicine was presented in an understandable manner. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

You would recommend this office/provider to a friend.

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Strongly Agree	*You would recommend this office/provider to a friend. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

You are pleased with your overall experience with this office.

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Strongly Agree	*You are pleased with your overall experience with this office. Strongly Agree Pick One
Agree	Agree Pick One
Neutral	Neutral Pick One
Disagree	Disagree Pick One
Strongly Disagree	Strongly Disagree Pick One

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