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.)

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