* 1. How did you hear about our office?

* 2. Why did you choose our office?

* 3. Which office were you seen in today?

* 4. Which surgeon did you see?

* 5. Were you scheduled promptly for your appointment?

* 6. How would you rate your telephone and scheduling experience?

* 7. Were you treated courteously upon your arrival to our office?

* 8. How much time did you have to wait from your appointment time until the time you saw the doctor?

* 9. Did the surgery team appear professional and technically competent?

* 10. Was the surgeon thorough in his explanation?

* 11. Did the doctor/staff explain the procedure and treatment to your satisfaction?

* 12. Were the preoperative and postoperative instructions clear and easy to follow?

* 13. If you did not schedule your surgery following your consultation, what was the reason?

* 14. Would you recommend our office to a family member or friend?

* 15. Any other comments or suggestions you would like to add?

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