We appreciate you taking the time to complete our survey. Please feel free to make any comments or suggestions you may have as to how we can improve your experience in the future.  Any comments you choose to make are kept strictly confidential and can only help us become better in the future.

*Patient name        

                   *e-mail address     

Please rate the following questions based on your experience at our office. 

    1.  Did you find the front office team to be friendly and courteous?

Excellent     Very Good     Average     Poor     Unacceptable

 

    2.  Were your insurance coverage benefits communicated clearly?

Excellent     Very Good     Average     Poor     Unacceptable

 

    3.  If you waited more than you expected, were you updated on the status of the schedule?

Excellent     Very Good     Average     Poor     Unacceptable

 

    4.  Do you feel that the nurse was courteous and sensitive to your needs?

Excellent     Very Good     Average     Poor     Unacceptable

 

    5.  Were the post operative instructions explained clearly?

Excellent        Very Good         Average         Poor       Unacceptable

 

     6.  Do you feel that the doctor was courteous and answered all your questions clearly?

Excellent     Very Good     Average     Poor     Unacceptable

 

    7.  Were you satisfied with the amount of time the doctor took to talk with you?

Excellent     Very Good     Average     Poor     Unacceptable

 

    8.  Do you feel that the doctor was concerned about your comfort during treatment?

Excellent     Very Good     Average     Poor     Unacceptable

 

  10.  Would you refer your friends and family to us?   

 Yes              No

 

    Please tell us how can improve your experience at our office.