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* 1. 1. Which provider did you see?

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* 2. What was the date of your appointment?


Date  

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* 3.    How do you rate the quality of appointment services?

  Excellent Very Good Good Fair Poor
Friendliness, sensitivity, and courtesy received from the check-in staff
Friendliness, sensitivity, and courtesy received from the nursing staff
Friendliness, sensitivity, and courtesy received from the check-out staff
Friendliness, sensitivity, and courtesy received from your physician

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* 4.  Please rate the quality of telephone or in-office services as it pertains to:

  Excellent Very Good Good Fair Poor
Billing questions

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* 5.
If you rated any response at good or below, please explain why? Please share specific examples so that we may educate our staff and or review our policies. We are committed to making changes necessary to achieve an excellent rating.

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* 6. What improvements can we make to better serve you?

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