It is important to us to maintain a practice with the highest level of patient care and service. We value your input to help us continually evaluate and evolve our service. Your willingness to respond to the following questions is greatly appreciated.
Please do not submit any Protected Health Information (PHI).
Was your initial contact with our office friendly? YesNo
Was your initial contact with our office informative? YesNo
Did you have any trouble finding our office? YesNo
Were you greeted in a friendly manner and made comfortable upon arrival? YesNo
Were you seen on time for your appointment? YesNo
Were the treatment and financial obligations explained thoroughly? YesNo
How would you rate your interaction/experience with our office staff? (5 being Very Satisfactory) --12345
How would you rate your interaction/experience with your doctor? --12345
How would you rate your overall experience? --12345