We want to be sure we are doing everything we can to serve you. Please take a minute to fill out this confidential survey. Just let us know what we are doing well and what we can to do better!

Patient Satisfaction Survey

Your Physician/Provider(Required)

Please indicate your level of satisfaction with the following items related to your office appointment.

Getting through to the office by phone.

The time between your call to schedule an appointment and your appointment date.

The manners of the person(s) who scheduled your appointment.

Clarity of directions to the office and the time of your appointment.

The professionalism and helpfulness of your reception.

Your wait time in the office.

The comfort, cleanliness and amenities of the reception area.

The extent to which staff respected your privacy.

Please rate the following items related to the delivery of your care.

Your physician/provider's listening skills.

His or her explanation, of procedures, diagnoses or treatment regimen.

His/her personal manner (courtesy, respect, sensitivity, friendliness.

Other staff's personal manner (courtesy, respect, sensitivity, friendliness).

Technical skills (thoroughness, carefulness, competence) of the physician/practitioner.

How prepared (records and educational materials readily available) the staff and physician/provider were for your visit.

Additional Information or Feedback (Optional)