Patient Satisfaction Survey

Were you seen our clinic today?
YesNo

The availability of appointment times:
PoorFairGoodVery GoodExcellent

The response time from your first contact to the initial appointment:
PoorFairGoodVery GoodExcellent

The quality of the parking area:
PoorFairGoodVery GoodExcellent

The quality of the waiting area:
PoorFairGoodVery GoodExcellent

The comfort/atmosphere of the office and exam rooms:
PoorFairGoodVery GoodExcellent

The thoroughness of the initial evaluation:
PoorFairGoodVery GoodExcellent

The adequacy of explanation of procedures:
PoorFairGoodVery GoodExcellent

The friendliness of your physician:
PoorFairGoodVery GoodExcellent

The friendliness of your receptionist:
PoorFairGoodVery GoodExcellent

The attention and respect to your privacy:
PoorFairGoodVery GoodExcellent

The attention given to what you had to say:
PoorFairGoodVery GoodExcellent

Your comfort in referring a friend or relative:
PoorFairGoodVery GoodExcellent

Your comfort in returning if you needed help again:
PoorFairGoodVery GoodExcellent

Your experience with the billing service:
PoorFairGoodVery GoodExcellent

Additional Comments: