Making sure that you receive the very best in medical care is our priority.

We would like to know how you feel about the services we provide in order to make sure that we are meeting your needs.

We do not just stuff these surveys in a folder somewhere, we read every response and use your feedback to make sure that we continue to do the things that are working well for you and make adjustments to things that might need some improvement.

All responses will be kept confidential. Thank you for taking the time to complete this survey and for allowing us to care for you!

Patient Name: *
Date of Birth: *
Your Sex?:
Please select a rating for how well you feel we are doing in the following areas (a score of 5 is best).
Ease of Getting Care
Ability to get in to be seen:
Hours Clinic is open:
Convenience of Clinic's location:
Prompt return of your phone calls:
Waiting
Time in waiting room:
Time in Exam Room:
Waiting for tests to be performed:
Waiting for test results:
Doctor
Listens to you:
Takes enough time with you:
Explains what you want to know:
Gives you clear advice and treatment:
Medical Assistants
Friendly and helpful to you:
Answers your questions:
Payment
What you pay:
Explanation of charges:
Collection of payment/money:
Facility
Neat and clean office:
Ease of finding where to go:
Comfort and safety while waiting:
Confidentiality
Keeping my personal information private:
The likelihood of refferring your friends and family to us:
What do you like best about our clinic?
What do you like least about our clinic?
What suggestions do you have for improvement?

Thanks again for taking the time to complete this survey!





By submitting this form you agree to our privacy policy and terms of service.

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