Patient Survey

1. How would you rate your overall experience with our practice?

 Excellent Above Average Average Below Average

2. How would you rate the phone manners of our staff?

 Excellent Above Average Average Below Average Poor

3. How would you rate the convenience of your appointment time?

 Excellent Above Average Average Below Average Poor

4. How would you rate the greeting upon your arrival?

 Excellent Above Average Average Below Average Poor

5. How would you rate the helpfulness of our staff?

 Excellent Above Average Average Below Average Poor

6. How would you rate the sensitivity and attentiveness of our doctor and staff?

 Excellent Above Average Average Below Average Poor

7. Where your questions answered at the consultation?

 Excellent Above Average Average Below Average Poor

8. How would you rate the surgical experience?

 Excellent Above Average Average Below Average Poor

9. Would you refer your family and friends to our practice?

 Yes No

10. Do you have any recommendations to improve the experience with our practice?

11. Did any staff members go out of their way to make your visit more pleasant or comfortable? If so, will you provide us with their names so that we may show our recognition?

12. Can we display your comments on our website?

 Yes No