Our goal is to provide quality medical care to our patients. We would like to know how you feel about our medical services, operations, physicians and staff members. Thank you for taking the time to help us meet your needs.

* 1. Visit Date:


* 2. Appointment With:

* 3. Your Appointment

  Excellent Very Good Good Fair Poor N/A
Ease of making appointments
Appointment available within a reasonable amount of time
The efficiency of the check in process
Waiting time in the reception area
Waiting time in exam room
Keeping you informed if your appointment time was delayed
Hours of operation convenient to you
Overall Comfort

* 4. Our Staff:

  Excellent Very Good Good Fair Poor N/A
The courtesy of the person answering the phone
The friendliness and courtesy of the receptionist
The caring concern of our medical assistants
The helpfulness of the billing department

* 5. Our Communication With You:

  Excellent Very Good Good Fair Poor N/A
Your phone calls answered promptly
Getting advice or help needed during office hours
Explanation of recommendations/testing
Your test results reported in a reasonable amount of time
Effectiveness of our health information materials
Our ability to return your calls in a timely manner
Your ability to contact us after hours
Your ability to obtain prescription refills by phone

* 6. Your Visit with the Provider:

  Excellent Very Good Good Fair Poor N/A
Willingness to listen carefully to you
Taking time to answer your questions
Amount of time spent with you
Explaining things in a way you could understand
Instructions regarding medication/follow up care
The thoroughness of the examination
Advice given to you on ways to stay healthy

* 7. Your overall satisfaction with:

  Excellent Very Good Good Fair Poor N/A
Our practice
The quality of your medical care
Overall rating of care from your provider or nurse

* 8. If you have had the opportunity to use your secure patient portal, how would you rate its usefulness?

  Excellent Very Good Good Fair Poor N/A
Overall Usefulness

* 9. Would you recommend the provider to others?

  Definitely No Probably No Don't Know Probably Yes Definitely Yes

* 10. If there is any way we can improve our services to you, please tell us about it: