* 1. Please indicate who your provider was.

* 2. How would you rate your experience with your physician or nurse practitioner?

* 3. How would you rate your experience with your provider's clinical support staff (MA or medical assistant)?

* 4. How would you rate your experience with our phone system?

* 5. How would you rate your experience with the individual who scheduled your appointment?

* 6. How would you rate your experience with our check-in/front desk area?

* 7. How were you referred to our practice?

* 8. How would you rate your overall experience at our office?

* 9. We always like to share positive comments from our patients - is there something or someone you'd especially like to recognize?

* 10. Do you have any suggestions regarding how we could have improved your experience at our office?

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