Tell us how we are doing!

Dear Valued Patient: The following Practice Information Survey is designed to help us improve our patient care. We would appreciate your taking the time to complete this questionnaire today if you have time. If not feel free to use the self addressed stamped envelope and mail back to us. All responses are essential in helping us assess our performance and your satisfaction. This critique will ultimately help improve our office efficiency and services.
Thank you for your time. Your feedback is an integral part of maintaining a quality practice!

Name (Optional)

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Date

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Was your telephone call answered promptly and courteously? *

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Comments

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Was it easy to get an appointment? *

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If you had contact with a phone nurse, were they professional & helpful? *

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Comments

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Do you find the appearance of the office pleasant?

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Was your waiting time in the waiting room reasonable? *

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Was the doctor’s explanation of your condition easy for you to understand? Were your questions completed answered? *

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When you were seated for your appointment today: Was the Medical Office Assistant, who seated you, professional & helpful? *

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Did you find the personnel at the reception desk and exit desk professional and helpful? *

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Did you find our bills understandable?

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Did you understand our financial policies? *

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How did you hear about us?












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Other

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What did you like best about our office?

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What did you like least?

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Phone

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