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Please take a few minutes and tell us how we are doing.
We appreciate your valuable time and comments.
All your responses will be held confidential! |
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How would you rate our clerical staff (check in, check out, appointment
coordinator) on: |
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Getting up to date information on you (insurance, demographics ext.)
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Great
Very Good
Good
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Fair
Poor
Not Applicable
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| Friendliness: |
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Great
Very Good
Good |
Fair
Poor
Not Applicable |
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| Patience: |
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Great
Very Good
Good |
Fair
Poor
Not Applicable |
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| Responsiveness: |
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Great
Very Good
Good |
Fair
Poor
Not Applicable |
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| Did our front desk person welcome you when you arrived? |
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yes no |
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Did our check out person thank you for coming to our practice during
the checkout process? |
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yes no |
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What was your overall impression with our billing department
(if applicable)? |
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| How would you rate our clinical staff (Medical Assistants, LPN and or RN's) on: |
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Who was your provider? |
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What office did you visit us at?
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Can you share with us your overall experience with our practice. Please be
as detailed as you can be. We want to know! |
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Would you recommend our practice to your relatives and friends?
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| What do you consider to be our strengths? |
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| What areas of our medical practice could we improve? |
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