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Patient Care Survey
 
We are always looking for ways in which we can improve the services we provide.  The input we receive from patients is especially valuable in helping us achieve this goal.  Thank you for taking the time to fill this out.
 
1) Was today your first visit to our office? 
 
 
2) Did our front office staff treat you in a friendly and professional manner?
 
  Disappointing - - - - - - - - - - - - - - -> Outstanding
 
 
3) Was necessary treatment explained thoroughly to you?
 
  Disappointing - - - - - - - - - - - - - - -> Outstanding
 
 
4) Were you seen on time? If not, how long did you wait?
 
 
 
5) Did you understand the fee and billing process, and was it fair?
  
 
 
6) Did we help as much as possible with the insurance process?
  
 
 
7) Were you disappointed with anything about our office?
  
 
 
8) Were any staff members particularly helpful during your visits to our office?
  
 
 
9) How can we improve our patient care?
(Help us improve our practice. Submit your suggestion for a chance to win a $25 gift card to Cameron Mitchell Restaurants!)
  
 
 
Please remember to tell your friends about us!  We are committed to striving for excellence and look forward to continuing that commitment.
 
 
Your Name: 
 
 
 
 
   
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