Exit Patient Satisfaction Survey Patient Satisfaction Survey The staff at the Dermatology & Laser Center of Chapel Hill thank you for participating in this survey. Your feedback will help us make sure we provide the best possible patient experience in our practice. Thank you! Question Title * 1. Please indicate the provider you would like to survey: Dr. Chris Adigun Leighanne McGill, PA-C Allyson Adamo, RN Other (please specify) Question Title * 2. What was the general purpose of your visit? Question Title * 3. What made you decide to choose our practice for your visit? Friend/family referral Physician referral Website Reputation/Experience of Doctor Information provided to me Magazine ad Cost Facility/Office location Social Media Other (please specify) Question Title * 4. When you called for your appointment, how would you rate the response from the person who answered the telephone? Excellent Good Average Fair Poor Excellent Good Average Fair Poor Other (please specify) Question Title * 5. When you arrived at the office, how would you rate the Front Office Representative in the following areas? Excellent Good Average Fair Poor Friendly and courteous? Friendly and courteous? Excellent Friendly and courteous? Good Friendly and courteous? Average Friendly and courteous? Fair Friendly and courteous? Poor Helpful? Helpful? Excellent Helpful? Good Helpful? Average Helpful? Fair Helpful? Poor Other (please specify) Question Title * 6. During your visit, how would you rate our clinic staff in the following areas? Excellent Good Average Fair Poor Friendly and courteous? Friendly and courteous? Excellent Friendly and courteous? Good Friendly and courteous? Average Friendly and courteous? Fair Friendly and courteous? Poor Helpful/Knowledgeable? Helpful/Knowledgeable? Excellent Helpful/Knowledgeable? Good Helpful/Knowledgeable? Average Helpful/Knowledgeable? Fair Helpful/Knowledgeable? Poor Competent and professional? Competent and professional? Excellent Competent and professional? Good Competent and professional? Average Competent and professional? Fair Competent and professional? Poor Sympathetic and caring? Sympathetic and caring? Excellent Sympathetic and caring? Good Sympathetic and caring? Average Sympathetic and caring? Fair Sympathetic and caring? Poor Other (please specify) Question Title * 7. During your visit, how would you rate the physician or physician assistant in the following areas? Excellent Good Average Fair Poor Friendly and courteous? Friendly and courteous? Excellent Friendly and courteous? Good Friendly and courteous? Average Friendly and courteous? Fair Friendly and courteous? Poor Competent and professional? Competent and professional? Excellent Competent and professional? Good Competent and professional? Average Competent and professional? Fair Competent and professional? Poor Sympathetic and caring? Sympathetic and caring? Excellent Sympathetic and caring? Good Sympathetic and caring? Average Sympathetic and caring? Fair Sympathetic and caring? Poor Other (please specify) Question Title * 8. Do you feel you were given adequate information about: Yes No The overall procedure The overall procedure Yes The overall procedure No The doctor's experience The doctor's experience Yes The doctor's experience No Total fees Total fees Yes Total fees No Possible side effects Possible side effects Yes Possible side effects No Procedure results Procedure results Yes Procedure results No Other (please specify) Question Title * 9. Please comment on any staff interaction and/or ideas how to improve our service. We learn the most directly from your comments, so please feel free to share without worries of offending us; our goal is to provide the highest patient experience imaginable! Question Title * 10. Would you like to give a patient testimonial using your first name only? Page1 / 1 100% of survey complete. Done