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

Your waiting time in our reception area:

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* 1. Your waiting time in our reception area:

Your waiting time in an exam room before your provider saw you:

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* 2. Your waiting time in an exam room before your provider saw you:

Ease of scheduling your appointment:

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* 3. Ease of scheduling your appointment:

The courtesy of the person who took your call:

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

The courtesy of the Call Nurse (if you spoke with one):

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* 5. The courtesy of the Call Nurse (if you spoke with one):

The friendliness and courtesy of the receptionist:

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* 6. The friendliness and courtesy of the receptionist:

Being kept informed if your appointment time was delayed:

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* 7. Being kept informed if your appointment time was delayed:

The caring concern of our nursing staff:

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* 8. The caring concern of our nursing staff:

The professionalism of our Ultrasound technicians (if you saw one):

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

The courtesy and warmth of your care provider:

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* 10. The courtesy and warmth of your care provider:

Your provider's willingness to listen carefully to you and answer your questions:

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

Your confidence in your care provider:

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* 12. Your confidence in your care provider:

The quality of the care you received from your provider:

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

Your overall satisfaction with our practice:

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* 14. Your overall satisfaction with our practice:

Would you recommend your care provider to others?

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

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.

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* 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 
7 am - 9 am
9 am - 12 pm
12 pm - 1 pm
1 pm - 5 pm
5 pm - 8 pm
What can we do to improve your experience with our practice?

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* 17. What can we do to improve your experience with our practice?

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