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* 1. Where you called and reminded of your appointment?

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* 2. Did your appointment begin on time?

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* 3. How helpful was the person at the front desk

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* 4. How Easy is the check in?

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* 5. Comments?

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* 6. How comfortable is the waiting area?

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* 7. How easy is it to find your way around?

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* 8. How clean is our facility?

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* 9. How friendly is the staff?

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* 10. How well was your service explained?

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* 11. How skilled is the staff?

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* 12. How concerned is the staff for you?

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* 13. Our concern for your privacy?

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* 14. Our sensitivity to your needs?

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* 15. Our response to your concerns?

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* 16. Staff's overall concern for you?

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* 17. Were you made to feel welcome?

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* 18. Were you treated with dignity and respect?

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* 19. Did the service meet your exspectations

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* 20. How the staff worked together for you?

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* 21. Overall rating of our services?

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* 22. Would you recommend us to others?

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* 23. Why or why not?

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