* 1. Which physician/sonographer did you see today?

* 2. What day of the week was your appointment?

* 3. Were you greeted upon arrival?

* 4. Was your wait time.............

* 5. How long did you have to wait until you were called to be escorted to an exam room?

* 6. Reason for your most recent appointment

* 7. How would you rate the cleanliness of our office?

* 8. How was your experience with our telephone staff?

* 9. How was your experience with our Front Office Staff?

* 10. How was your experience with our Clinical Staff?

* 11. How would you rate your overall experience?

* 12. Would you recommend our office to your family and friends?

* 13. How did you hear about our office?

* 14. Additional Comments

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