Marias Healthcare Services, Inc

Marias Healthcare appreciates your time in completing this survey.

Your answers will be reviewed by both the management and Board of Directors. Your feedback is important to us as we strive to provide the best care possible.

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* 1. At which office were you seen?

Dental

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* 2. Which Physician did you see?

Dr. Woolfe, DMD

Other (please specify)

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* 3. Date of appointment?

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* 4. Was this your first visit to Marias Healthcare?

Yes

No

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* 5. How would you rate the following?

	Very Good	Good	Fair	Poor	Very Poor
Convenience of office hours.	Convenience of office hours. Very Good	Convenience of office hours. Good	Convenience of office hours. Fair	Convenience of office hours. Poor	Convenience of office hours. Very Poor
Comfort of reception area.	Comfort of reception area. Very Good	Comfort of reception area. Good	Comfort of reception area. Fair	Comfort of reception area. Poor	Comfort of reception area. Very Poor
Comfort of exam rooms.	Comfort of exam rooms. Very Good	Comfort of exam rooms. Good	Comfort of exam rooms. Fair	Comfort of exam rooms. Poor	Comfort of exam rooms. Very Poor

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* 6. How would you rate the confidentiality of:

	Very Good	Good	Fair	Poor	Very Poor	N/A
Receptionists	Receptionists Very Good	Receptionists Good	Receptionists Fair	Receptionists Poor	Receptionists Very Poor	Receptionists N/A
Nurses/Clinical Staff	Nurses/Clinical Staff Very Good	Nurses/Clinical Staff Good	Nurses/Clinical Staff Fair	Nurses/Clinical Staff Poor	Nurses/Clinical Staff Very Poor	Nurses/Clinical Staff N/A
Physicians	Physicians Very Good	Physicians Good	Physicians Fair	Physicians Poor	Physicians Very Poor	Physicians N/A
Office Staff/Account Services	Office Staff/Account Services Very Good	Office Staff/Account Services Good	Office Staff/Account Services Fair	Office Staff/Account Services Poor	Office Staff/Account Services Very Poor	Office Staff/Account Services N/A