Please rate your experience with the following aspects of your visit:

* 1. Waiting time in the reception area

* 2. Waiting time in the exam room

* 3. Ease of scheduling your appointment

* 4. The courtesy of the person who took your call

* 5. Courtesy of the Call Nurse (if you spoke with one)

* 6. The friendliness and courtesy of the receptionist

* 7. Keeping you informed if your appointment time was delayed

* 8. The caring concern of our nurses

* 9. The professionalism of our Ultrasound technicians (if you saw one)

* 10. The courtesy and warmth of your care provider

* 11. Your provider's willingness to listen carefully to you and answer your questions

* 12. Your confidence in your care provider

* 13. The quality of the care you received from your provider or nurse

* 14. Your overall satisfaction with our practice

* 15. Would you recommend your care provider to others?

* 16. We are considering expanding our office hours, in order to provider more convenient appointment times for our patients.  Please check off the days/times that you would prefer.

  Monday Tuesday Wednesday Thursday Friday Saturday (8-12 and/or 1-5 only)
7 am - 9 am
9 am - 12 pm
12 pm - 1 pm
1 pm - 5 pm
5 pm - 8 pm
8 am - 12 pm (Saturdays)
1 pm - 5 pm (Saturdays)

* 17. How can we improve your services to you?

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