About Us

Patient Survey

Your Name

Date of Your Visit

Was the scheduler helpful in making your appointment?

Did you get the appointment of your choice?

Was the scheduler friendly, warm and caring?

Were you greeted warmly by the receptionist in a timely manner?

Did the receptionist explain the forms and how you needed to fill them out?

Was your wait time acceptable in the waiting room?

Were any delays explained?

Did the nursing staff introduce themselves?

Did the nursing staff explain what they were doing and why?

Was the nursing staff friendly, warm and caring?

Did you find your wait time acceptable in the exam room?

Did your provider (doctor or nurse practitioner) spend enough time with you?

Did your provider (doctor or nurse practitioner) answer all of your questions?

Was the front office staff helpful in making any return appointment you needed to schedule?

Would you recommend this office to your friends or family members?

Overall, were you satisfied with your visit today?

Why?

Were you happy with any staff member today?

Why?

Were you dissatisfied with any staff member today?

Why?

Additional Comments or Suggestions: