We are interested in knowing how you feel about your patient experience at our practice. Your assistance is extremely important in helping us continue to provide excellent patient care.
Which office did you visit today?

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* 1. Which office did you visit today?

Please rate the following:
The ability to schedule an appointment promptly

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* 2. The ability to schedule an appointment promptly

The convenience of the office location

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* 3. The convenience of the office location

The accessibility of the office. Is it easy to find? Is the handicapped entrance adequate?

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* 4. The accessibility of the office. Is it easy to find? Is the handicapped entrance adequate?

The comfort and attractiveness of the reception area

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* 5. The comfort and attractiveness of the reception area

The comfort of the examination rooms

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* 6. The comfort of the examination rooms

The cleanliness of the office including the reception area and the examination rooms

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* 7. The cleanliness of the office including the reception area and the examination rooms

The courtesy of the staff

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* 8. The courtesy of the staff

Which provider did you see?

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* 9. Which provider did you see?

The amount of time spent with your physician / communication with the
physician and the quality of care received. 

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* 10. The amount of time spent with your physician / communication with the
physician and the quality of care received. 

Overall, how would you rate your experience?

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* 11. Overall, how would you rate your experience?

How likely are you to recommend us to others

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* 12. How likely are you to recommend us to others

Do you have any additional comments?

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* 13. Do you have any additional comments?

If you would like to receive a follow-up call from our office, please provide your information below.

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* 14. If you would like to receive a follow-up call from our office, please provide your information below.

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