1. Default Section

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* 1. Please rate your satisfaction with your appointment scheduling experience.

  Very Satisfied Somewhat Satisfied Somewhat Unsatisfied Unsatisfied Not Applicable
Tell us if you were satisfied with the amount of time it took to speak to a member of our appointment desk team.
Tell us if you were satisfied with the amount of time it took to speak with a member of our triage nursing team?
Were you satisfied with the appointment desk's ability to accomodate your scheduling needs?
Were you satiisfied with our triage nursing team's ability to accomodate your scheduling needs?

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* 2. Which provider did you see at your last visit?

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* 3. Please rate your satisfaction with the wait time in the exam room.

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* 4. Mark the boxes that characterize the demeanor of your Provider.

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* 5. Please rate your satisfaction with the courtesy of our staff.

  Very Satisfied Somewhat Satisfied Somewhat Unsatisfied Unsatisfied Not Applicable
Appointment Desk
Check In
Nursing
DEXA
Physician
Insurance - in office
Insurance Billing
Surgery Scheduling
Check Out
Ultrasound
Urodynamics
Phlebotomist
Nursing (triage phone team)

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* 6. Would your recommend your Provider and our Practice to your family and friends? Why or why not?

  Yes No Maybe
Would you recommend your Provider?
Would you recommend our Practice?

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* 7. We welcome any other comments you may have. Please type them in this box. You can also use this space to tell us about any other services you would like us to provide. If you wish to be contacted personally, please include your name and phone number.

Thank your for participating in our survey!

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