* 1. How likely is it that you would recommend this company to a friend or colleague?


* 2. Do you have any other comments, questions, or concerns?

* 3. How well did our customer service representative answer your question or solve your problem?

* 4. During your most recent visit, did your healthcare provider seem to know the important information about your medical history?

* 5. During your most recent visit, did you talk with your healthcare provider about any health questions or concerns?

* 6. In the last 12 months, how many times did you visit your healthcare provider?

* 7. Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your healthcare provider?

  10 Best provider possible 9 8 7 6 5 4 3 2 1 0 Worst provider possible

* 8. How long have you been going to your healthcare provider?

* 9. Overall, how would you rate the service you received from the staff at our office?

* 10. Would you recommend your healthcare provider’s office to your family and friends?