* 1. PLEASE RATE THE FOLLOWING:
Your Appointment

  Excellent Very Good Good Fair Poor N/A
Appointment availability within a reasonable amount of time.
The efficiency of the check-in process.
Waiting time in the reception area.
Waiting time in the exam room.
Keeping you informed if your appointment was delayed.

* 2. Our Staff

  Excellent Very Good Good Fair Poor N/A
The courtesy of the person who took your call.
The friendliness and courtesy of the receptionist.
The caring concern of our medical assistants.
The helpfulness of the people in our business office.
The overall appearance of our staff.
Was our surgery scheduler helpful and informative?
The staff was sensitive to my privacy?

* 3. Our communication with you

  Excellent Very Good Good Fair Poor N/A
Was your phone call answered promptly.
Availability of medical information/advise by telephone.
Explanation of your procedure/treatment.
Your tests results reported in a reasonable amount of time.
The staff returning your calls in a timely manner.

* 4. Your visit with our providers

  Excellent Very Good Good Fair Poor N/A
The provider (physician or physician assistant) listening to you.
The provider taking time to answer your questions.
Amount of time the provider spent with you.
The provider adequately explaining treatment options.
The providers instructions regarding medication/follow up care.
The thoroughness of the examination.
Was the provider friendly and courteous?

* 5. Your overall satisfaction with:

  Excellent Very Good Good Fair Poor N/A
The appearance and neatness of the office.
Our practice.
The quality of your medical care.

* 6. If there is any way we can improve our service to you, please let us know:

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