Please tell us about your visit.

1. What was the approximate date of the most recent visit?

2. Was this a new or return appointment?

3. Was the appointment for you or a family member?

4. What was the reason for your visit? (check ALL that apply)

5. How would you describe your experience in scheduling an appointment?

6. How did you request your appointment? (please check one box below)

7. Which office location in Georgia did you visit?

8. Which podiatrist did you see?

9. How would you describe our staff's level of helpfulness and courtesy?

10. How would you describe the wait time to see your doctor?

11. How would you describe the doctor's level of care in answering your questions and meeting your needs?

12. Which diagnostic tests were ordered?

13. How would you describe the overall quality of your visit?

14. Would you recommend our practice to others?

15. Have you visited our web site for any of the following?

16. Please share your comments or suggestions regarding our practice:

17. Please provide your contact information: (optional)

* 18. Do you give permission to Village Podiatry Centers to publish your comments on our website or marketing materials? (Only first name and city will be used.)