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) Which location did you visit?
(2) What was the reason/purpose of your visit?
If Other, please specify
(3) Was this your first visit to our office?
(4) When you arrived at our office, were you greeted in a prompt and courteous manner by the receptionist?
If No, please explain
(5) Did you encounter any difficulty in making the appointment for today's visit?
If Yes, please explain
(6) Did you find the appointment time frame to be acceptable?
If No, how long did you wait to get an appointment?
(7) How long did you have to wait before being seen?
(8) Did the nurses/medical assistants treat you in a courteous and professional manner?
(9) If you saw the doctor, did he treat you in a courteous and professional manner?
(10) Were all your questions answered?
(11) Overall, how would you rate your visit to our office?
(12) Would you recommend our office to a friend/relative?
Additional Comments