Please choose your doctor:
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1.
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The appointment process was satisfactory.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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2.
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The check-in/check-out process was a pleasant experience.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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3.
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The staff was professional.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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4.
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My doctor spent adequate time with me.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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5.
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My doctor was sensitive to my needs.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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6.
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My doctor clearly communicated my diagnosis and treatment plan.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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7.
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I have confidence in my doctor and I believe he gave me great advice.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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8.
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The appearance of the practice was neat and pleasing.
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Strongly Agree
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Agree
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Neither Agree nor Disagree
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Disagree
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Strongly Disagree
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N/A
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9.
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The wait in the front office was:
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Less than 15 minutes
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16-30 minutes
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31-45 minutes
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46-60 minutes
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Over an hour
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10.
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The wait in the exam room was:
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Less than 15 minutes
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16-30 minutes
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31-45 minutes
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46-60 minutes
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Over an hour
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11.
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Please share any additional comments.
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12.
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If you would like someone to contact you in regard to your survey and/or comments, please include your contact information. Thank you.
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Name
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Email
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