Patient Satisfaction Survey

  • We are interested in receiving your feedback about the care provided at our office. Please take a few minutes to complete this survey and return it to us. Your responses are important to us.

  • Extremely DissatisfiedVery DissatisfiedSatisfiedVery SatisfiedExtremely Satisfied
    Ease of making appointment for checkups (physical exams, well visits, routine follow-up appointments)?
    Ease of making appointments for sickness?
    Ease in contacting your doctor when our office is closed (nights and weekends)?
    Ease in speaking directly with your doctor by telephone when you call during office hours?
    The time it takes someone from our office to respond when you call the office with an urgent problem?
    Waiting time in our office?
    Ease in obtaining follow-up information and care (test results, medicines, care instructions)?
    Overall medical care at your doctor’s office?
    Our office’s appearance?
    Our office’s convenience (location, parking, hours, of ce layout)?
    The way we teach you about improving your health?
    The way your doctor involves other doctors and caregivers in your care when needed?
  • Extremely UncaringVery UncaringCaringVery CaringExtremely Caring
    Your doctor?
    Our medical staff?
    Our office staff?
  • Definitely NotProbably NotNot SureProbablyDefinitely
  • These questions pertain to the patient to whom this survey was addressed:

  • These questions pertain to the responsible party: