1: Ease of making appointments? 12345678910
2: Appointment available within a reasonable amount of time? 12345678910
3: Waiting time in the reception area/exam room? 12345678910
4: The friendliness and courtesy of the receptionist? 12345678910
5: The friendliness and courtesy of the Assistant? 12345678910
6: The friendliness and courtesy of the Doctor? 12345678910
7: Did we meet your expectations? 12345678910
8: Quality of care provided by our office? 12345678910
Would you like someone from our office contact you to address your concerns? YesNo
9: Any suggestions on how we can improve?
Name:
Email:
Phone: