Are you a new or returning patient?

Which provider did you visit?

When you called the office, how would you rate how quickly someone answered the phone?

How would you rate the friendliness and courteousness of the person on the phone?

How many minutes did you wait to see a provider?

How would you rate the front office process?

How friendly and courteous was the front office staff?

How would you rate the overall comfort of the facility?

How would you rate the clinical staff members (nurses, medical assistants, technicians, etc…) that were part of your visit?

How would you rate the amount of time your provider spent with you?

How would you rate how attentive and responsive the provider was to your questions?

How would you rate the level of trust that you had with your provider and did you feel that he or she made health decisions in your best interest?

How would you rate the effectiveness of informational materials you received?

If you spoke to someone in the billing department, how would you rate their friendliness and courteousness?

If you spoke to someone in the billing department, how would you rate their responsiveness and ability to address your needs?

How would you rate your overall satisfaction today?

How did you hear about our practice?

How likely are you to refer this practice to your friends and family?

What is your name?

What is your email address?

Additional Comments:

The feedback you provide is incredibly valuable to us and will help improve our services in the future. By checking the box, you understand that we may use your comments to promote our physicians and offices on our social media pages, either anonymously or utilizing your first name and last initial. We respect your privacy and are committed to ensuring that your personal information is secure. Thank you for your continued support.

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