Today's visit:

Here are some questions about your most recent visit to our office.
Kindly complete this questionnaire. Thank you so much!

* 1. Were you able to make an appointment at a convenient time?

* 2. On the day of your appointment did you have to wait more than 20 minutes to see your provider?

* 3. Was our staff courteous and professional?

* 4. Did you have a favorable provider visit?

* 5. Were all your concerns and questions addressed during your visit?

* 6. How would you rate your satisfaction with getting the help that you came here for?

* 7. What is your age?

* 8. Are you male or female?

* 9. What can we do to improve your next visit? Please provide name so we can follow-up.

* 10. Would you recommend us to a family member or friend?