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.

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* 1. Which office did you visit today?

Please rate the following:

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* 2. The ability to schedule an appointment promptly

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* 3. The convenience of the office location

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

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* 5. The comfort and attractiveness of the reception area

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* 6. The comfort of the examination rooms

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

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* 8. The courtesy of the staff

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* 9. Which provider did you see?

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

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

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

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* 13. Do you have any additional comments?

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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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