* 1. Which medical provider did you see during your last visit?

* 2. Were you able to schedule an appointment within a reasonable amount of time?

* 3. Once you arrived, did the provider see you within a reasonable amount of time?

* 4. Was the staff pleasant?

* 5. Was the provider pleasant?

* 6. Did you feel the provider listened to your needs?

* 7. Did the provider explain your diagnoses and/or procedures to your satisfaction?

* 8. Was the front desk staff pleasant and helpful?

* 9. During your last phone conversation with our office, was the staff pleasant on the phone?

* 10. Overall, how satisfied were you with your last office visit?

* 11. Would you recommend Pulmonary Practice Associates to your friends and family?

* 12. If you have any special comments or concerns about you most recent experience with our practice and would like to speak with our customer service manager, please provide your name and phone number.

* 13. Questions / Comments / Concerns

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