patient-survey

Optional

First Name

Last Name

Please select your doctor (Required)*

Appointments

Excellent

Very Good

Good

Fair

Poor

Ease of scheduling appointments*

Appointment availability*

The efficiency of the check-in process*

Waiting time in the reception area*

Waiting time in the exam room*

Office Staff

Excellent

Very Good

Good

Fair

Poor

Name (Optional)

First Last

Email (Optional)

The courtesy of the person who took your call*

The friendliness and courtesy of the receptionist*

The caring concern of our medical assistants*

The helpfulness of the people who assisted you with billing or insurance*

Our Communication with you

Excellent

Very Good

Good

Fair

Poor

Phone calls answered promptly*

Getting advice or help when needed during office hours*

Test results reported in a reasonable amount of time*

Ability to return your calls in a timely manner*

Ease of obtaining prescription refills*

Your time with the provider

Excellent

Very Good

Good

Fair

Poor

Willingness to listen carefully to you*

Taking time to answer your questions*

Amount of time spent in appointment*

Instructions regarding medication / follow-up care*

The thoroughness of the examination*

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Patient Information

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