Dear Patient:

In an ongoing effort to improve your experience with our office, we would greatly appreciate it if you would take a few moments to answer the following questions.

Thank you!

(1) Ease in Scheduling Appointment

(2) Welcome by Receptionist

(3) Check-in Process

(4) Appearance of the reception staff

(5) Office Staff's help with your insurance paperwork

(6) Waiting time in the lobby

(7) Literature/reading materials in lobby

(8) Adequacy of parking

(9) Cleanliness in surroundings

(10) Friendliness and helpfulness of nursing staff during your visit

(11) Availability of literature regarding your condition or illness

(12) Friendliness of the physician

(13) Physician's concern for you

(14) Physician's thoroughness

(15) Physician's answers to your questions

(16) Quality of information given by the clinical staff

(17) Friendliness/helpfulness of the nursing staff

(18) Financial policies, arrangements, or payment plans

(19) Check-out process is smooth and efficient

(20) Overall, how satisfied or dissatisfied are you with our services

Additional Comments